Department of Oral & Maxillofacial Surgery s1

DISSERTATION – SYNOPSIS

Dr. HARDIK .S. RUPARELIYA

POST GRADUATE STUDENT

DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY

A.J. INSTITUTE OF DENTAL SCIENCES, KUNTIKANA, MANGALORE. 2013-2014 Rajiv Gandhi University of Health Sciences, Karnataka,Bangalore.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the Candidate Dr. HARDIK.S.RUPARELIYA

And Address POSTGRADUATE STUDENT, DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY ( in block letters ) A .J. INSTITUTE OF DENTAL SCIENCES, KUNTIKANA MANGALORE – 575004 2. Name of the institution A .J .INSTITUTE OF DENTAL SCIENCES, MANGALORE

3. Course of study and MASTER OF DENTAL SURGERY (M.D.S) subject ORAL & MAXILLOFACIAL SURGERY

4. Date of admission to 14/6/2013 course

5. Title of the topic :

EVALUATE THE EFFICACY OF 3-D MINI PLATES USED IN ORAL AND MAXILLOFACIAL TRAUMA - A PROSPECTIVE STUDY 6 Brief resume of the intended work :

6.1 Need for study

Internal fixation of maxillofacial region fractures using plates and screws is now an established method of treatment. However, maxillofacial regions have differing 3- dimensional instability modes, including bending, twisting, shearing and axial displacements. Owing to these biomechanical differences, ideal bone plate design differs. The purpose of the study is to evaluate the efficacy of three dimensional miniplates as treatment modality for the stabilization of the fractured bone fragments in maxillofacial region.3 dimensional (3D) miniplates, consisting of two 2-hole miniplates with gap which are interconnected by vertical cross struts. Three- dimensional mini plates and screws were developed and were reported first by Farmand and Dupoirieux, Unlike compression and reconstruction plates, their stability is not derived from the thickness of the plate. In the combination with the screws monocortically fixed to outer cortical plate, the rectangular plates form a cuboid, which possess 3D stability. The 3D plating system is based upon the principle of obtaining support through geometrically stable configuration. The quadrangle geometry of plates assures a good stability in three dimensions of the fracture site since it offers good resistance against torque forces.

6.2 Review of literature

1. Gaurav Mittal, Ramakanth Reddy Dubbudu, K. M. CariappaJ et al. in 2011 did a study to evaluate the efficacy of three dimensional miniplates as treatment modality for the stabilization of the fractured or osteotomized bone fragments in maxillofacial region. Conclusions Three dimensional plates provide good stability of bone fragments due to closed quadrangular geometric shape, and the ease of contouring and adapting. Because of better inter fragmentary stability, supplemental fixation is not necessary, thereby enhancing the overall comfort, convenience and well being of the patient.

2. Lovald Scott, Baack Bret, Gabbal Curtis et al. in 2010 did a study to design and optimize a bone plate for fracture of mandibular symphysis that will provide maximum stability with minimal implanted volume and patient intrusion. Results demonstrated that the new optimized plate is a hybrid of fixation hardware with small profile of smallest miniplate configuration and superior fixation strength.

3. Jain M.K., Manjunath K.S., Bhagwan B.K. et. al in 2010 carried out a prospective randomized clinical trial on 20 patients for comparison of 3-D and standard miniplate fixation in management of mandibular fracture. The conclusion of trial was that the 3-D miniplate system provides good stability and operative time is less because of simultaneous stabilization at both inferior and superior borders. However, it is unfavorable for use in cases of oblique fracture.

4. Juergen Zix, Lieger Olivier, Iizuka Tateyuki in 2007 conducted a study in 20 patients with non comminuted mandibular angle fracture. All patients were treated with open reduction and internal fixation using 2mm straight and curved 3-D miniplate system via a transoral approach. They concluded that 3- D plating system is suitable for fixation of simple mandibular angle fractures and is an easy to use alternative to conventional miniplates.

5. Guimond Claude, Jhonson J.V., Marchena J.M. in 2005 did a retrospective evaluation of 37 patients with non comminuted mandibular angle fracture fixated with trans orally placed 3-D 2mm curved angle strut plate. The geometry of curved 3-D strut plate conceptually allows for stability in 3 dimensions and resistance against torque forces while maintaining a low profile and malleability.

6. Mukerji R., Mukerji G., Mcgurk M. in 2006 presented a historical overview of techniques and systems used for stabilization of mandibular fractures. Now open reduction is the norm and tiny titanium plates are used to immobilise fragments of the jaw. Morbidity of the procedure is low with the advantage that the patient returns to normal function within days of treatment.

6.3 OBJECTIVES

To study and evaluate the efficacy of three dimensional miniplates as treatment modality for the stabilization of the fractured bone fragments in maxillofacial regiona and to achieve accurate reduction and fixation of the fracture.

7 Material and method

7.1 Source of data

Patients referred or reporting to the Department of Oral & Maxillofacial Surgery, A.J.institute of dental sciences,mangalore for treatment of maxillofacial fractures.

Sample size – 10

Sampling technique: Convenience sampling

Selection of patients

Inclusion Criteria :

1. Patients of both genders between the age group of 18-60 years with non comminuted maxillofacial region fractures. 2. ASA I and ASA II category.

Exclusion criteria :

1. Patients with comminuted fracture. 2. Patients with uncontrolled systemic disease who are unfit to undergo surgery under general anaesthesia.

7.2 Method of collection of data(including sampling procedure if any)

Pre operatively fracture will be assessed by clinical(occlusion, nerve deficit) and radiographic methods,

Post operatively the patients should evaluate for Interfragmentary stability, maximal mouth opening and signs of infection, occlusion after treatment and supplemental fixation, hardware complications like broken plates and screws

post-operative data will be collected in 3 phases:- a) Immediate post-op b) 2 week post op c) 2 month post op

7.3 Does the study requires any investigations or intervention to be conducted on patients or other humans or animals?

Yes The study requires routine blood investigations and periodic radiographs of patients to be done both pre operatively and post operatively.and open reduction and internal fixation done with 3-d mini plates.

7.4 Has the ethical clearance been obtained from your institution in case of the above?

Yes BIBILOGRAPHY 1 Guimond C., Johnson J.V, Marchena J.M., 2005 “ Fixation of Mandibular Angle Fractures With a 2.0mm 3-Dimensional Curved Angle Strut Plate” J Oral Maxillofac Surg 63: 209-214.

2 Mukerji R., Mukerji G., McGurk M., 2006 “ Mandibular fractures: Historical perspective” British Journal of Oral and Maxillofacial Surgery 44: 222–228. 3

Zix J., Lieger O., Iizuka T. 2007 “ Use of Straight and Curved 3-Dimensional Titanium Miniplates for Fracture Fixation at the Mandibular Angle” J Oral Maxillofac Surg 65:1758-1763. 4

Jain M.K, Manjunath K.S, Bhagwan B.K, et.al 2010 “Comparison of 3- Dimensional and Standard Miniplate Fixation in Management of Mandibular Fractures” J Oral Maxillofac Surg 68: 1568-1572. 5

Lovald S., Baack B., Gabbal C. et al. 2010 “Biomechanical Optimization of Bone Plates Used in Rigid Fixation of Mandibular Symphysis Fractures” J Oral Maxillofac Surg 68:1833-1841. 6

Feledy j : treatment of mandibular angle fracture with a matrix miniplate:a preliminary report.plastic and reconstructive surgery.114:1711-1718,2004 7

Farmand M: The 3 –dimentional plate fixation of fractures and osteotomies.facial plast surg 3:39,1995 8

Champy M,Lodde Jp & Jaeger JH:mandibular osteosynthesis according to the Michelet technique I,biomechanical bases77:569-576,1976 9

Gaurav Mittal, Ramakanth Reddy Dubbudu, K. M. CariappaJ et al. in 2011 to evaluate the efficacy of three dimensional miniplates as treatment modality for the stabilization of the fractured bone fragments.

9. Signature of the candidate

10. Remarks of Guide

11.1 Name and Designation of Guide DR. NAVEEN RAO PROFESSOR, DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY A J INSTITUTE OF DENTAL SCIENCES, MANGALORE.

11.2 Signature of the Guide

11.3 Co-Guide (if any)

11.4 Signature of the Co-Guide ( if any)

11.5 Head of the Department DR. NANDESH SHETTY PROFESSOR AND H.O.D., DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY A J INSTITUTE OF DENTAL SCIENCES, MANGALORE.

11.6 Signature of the Professor & Head of the Department.

12 12.1 Remarks of chairman and principal:

12.2 Signature