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Journal of Maxillofacial Trauma 2012 April;1(1):2-12


lingua: Inglese

Modifications of a halo-supported external fixator as an adjunct to complex maxillofacial trauma: a report of 10 cases

Lewallen J. B. 1, Frederick J. W. 2, Press S. G. 1

1 Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; 2 Oral and Facial Surgery of the Shoals, Sheffield, AL, USA


We present a series of ten cases where a modified, halo-supported, external distractor was used as an adjunct in treating complicated maxillofacial trauma with an emphasis on mandibular stabilization. Cases were retrospectively reviewed for maxillofacial trauma patients at one trauma center between 2008 and 2011. Distractors were modified on an individual basis using select components of mandibular external fixation sets, orthopaedic toggles, and the midface distractor components. We collected information on patient demographics, functional ability, estimated surgical blood loss, length of device use, and other procedures performed. Subjective analysis focused on function, esthetics, and complications. Ten patients with complicated facial fractures and soft tissue injuries required use of the cranially supported distractors as an adjunct to primary hard and soft tissue repair. The patients were predominately male (8 males), with a mean age of 47 years (range 28-68). Distractors were worn between 24 and 124 days. The majority of the injuries occurred secondary to gunshot wounds. In all ten patients, fracture management was successfully aided with the use of the external distractors, and there were no major complications other than restricted range of motion, patient complaints, and pin loosening. Modified rigid external distraction devices can be used as an adjunct in complicated maxillofacial trauma management to stabilize mandibular segments without significant complications. Possible indications include 1) unpredictable maxillomandibular fixation; 2) complex avulsive injuries at risk of devitalization of underyling tissue; 3) and compromised anteriorposterior or vertical bony support that restricts the airway.

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