A novel fixation method for panfacial fracture using an Ilizarov-type external fixator

Abstract

In general, internal plate fixation is mainly performed in order to reduce multiple facial bone fractures and rarely uses an external fixator. Although it would be ideal to successfully achieve or preserve the occlusal relationship of the upper and lower jaws, it is difficult to successfully manage multiple bone fragments in order to use them to achieve internal fixation, especially when treating a severely comminuted facial fracture. In addition, it is also important to prevent the onset of severe infection after sub-periosteal dissection, due to the presence of avascular bony fragments and an internal fixation implant which thus represents a foreign body. In order to treat extensive comminuted fracture without internal plate fixation, we performed external fixation using an Ilizarov-type external fixator. The Ilizarov-type external fixator is characterized by a few circular external structures and threaded rods. This device can be modified for use in the field of orthopedic surgery to correct three-dimensional deformities caused by fragile complicated fractures and bone defects. The advantages of the Ilizarov-type external fixator for treating panfacial fractures include a low invasiveness, utility in various fracture situations, easy adjustment of threaded rods, and a low potential cost. We herein report the first case of a severe panfacial fracture that was successfully treated using an Ilizarov-type external fixator.

Off-Label Treatment for Severe Craniomaxillofacial Fractures in Low-Income Countries—A Novel Operation Method with the External Face Fixator

“…Hihara et al showed similar insertion site selection in their case study published in 2019. In particular, the pins in the hard palate were placed in the same location [ 8 ]. The alternative is to insert one pin in the zygomatic bone on each side.…”

“…The use of an Ilizarov-type external fixator for CMF was first described in a case report by Hirara et al in 2019. This type of fixation was chosen as an alternative to plate osteosynthesis due to an uncontrollable intraoral bleeding caused by a severe panfacial fracture of a 70-year-old woman [ 8 ]. In high-income countries (HIC) these factures are treated with mini-plates, even in extensive comminuted fractures [ 9 , 10 ].…”

“…As external fixators are usually the first implant for emergency hospitals in trauma care, their use for CMF becomes evident. We widened the indication for the use of hand external fixator for the CMF as an external face fixator (EFF) in a LIC setting [ 8 , 14 ]. This model was chosen because, on the one hand, it is also usually available in LIC and the 4 mm diameter of the pins seems clinically adequate.…”

Reference point and confirming points; two important guides in treatment of panfacial Fx.: 3 case reports

“…(1). Furthermore there are different approaches for exposure and fixation based on experience of the surgeon (8). Some surgeons considered reconstruction of occlusion as the first step in treatment and begin with mandible.…”

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100thbirthday of G. A. Ilizarov)

“…It was applied for traumatic skull defects and brain vascularity stimulation after brain stroke but the techniques remained on the stage of uncompleted clinical trials. On the contrary, the role and significance of craniomaxillofacial distraction procedures have been much discussed in the specialized literature and has been found applicable in craniofacial deficiency or dentofacial anomalies that are corrected with distraction procedures and special devices[ 132 , 133 ]. Another Ilizarov’s idea of stimulating the vascularity in chronic ischemic diseases in the lower extremities has been revived and its modification has been called tibial transverse distraction[ 134 , 135 ].…”