Factors of Successful Treatment Using the Bone Lid Technique in Maxillofacial Surgery: A Pilot Study

Abstract

This study aimed to investigate the success factors of the bone lid surgery technique in the maxillofacial region. A retrospective cohort study was performed on 30 maxillofacial patients who underwent bone lid surgery between January 2014 and December 2019 at our hospital. The predictor variables consisted of clinical factors that were classified as attribute (age and sex), health status (smoking and alcohol intake), anatomical (maxillary/mandibular site, left/right side, and cortical bone thickness), lesion (lesion size, location, and pathological diagnosis), and treatment variables (differences in absorbable osteosynthesis materials). The outcome variable was the incidence of bone lid necrosis after surgery. Various risk factors for postoperative bone lid necrosis were investigated statistically. A value <0.05 was considered statistically significant. Postoperative bone lid necrosis was observed in three patients (10.0%). No significant differences in the attribute, anatomical, and treatment status variables were noted. Significant differences were observed between smoking (p=0.005) and alcohol intake (p=0.003) in the health status variables. There was a significant difference in the distance of the lesion from the alveolar bone crest in the lesion variables (p=0.037). Smoking and alcohol consumption were the health status variables found to be risk factors for bone lid necrosis. In addition, proximity to the alveolar crest was also a risk factor for lesion development.

The Bone Lid Technique in Oral and Maxillofacial Surgery: A Scoping Review

“…In a retrospective cohort study, approximately one third of the included patients were smokers, and smoking habit was found to be a risk factor for bone lid necrosis (p = 0.005). Indeed, necrosis was observed only in smokers [46].…”

“…In half of the included papers, the surgical procedures were performed under local anesthesia, while in the other three articles, they were also completed in combination with conscious sedation [4,46] or general anesthesia [17,46]. In three studies, the surgeries were carried out either under general or local anesthesia [48,52,54].…”

“…Bone lid resorption, necrosis, and removal were rather infrequent, as only 20 cases were found out of 752, of which 5 were in the maxilla [26,51,53] and 12 were in the mandible [1,3,4,46,48], while it was not specified in 3 cases [9]. In 5 cases out of 17, bone lid complications were clearly associated with suture stabilization or no fixation [1,48,53], 2 with rigid fixation methods [4,26], and 3 with resorbable plates [46]; whereas in 10 cases, the fixation method could not be identified [3,9,51]. In Sukegawa et al, different resorbable plates were utilized, and the osteosynthesis material was not found to be related to the bone lid necrosis [46].…”

“…In 5 cases out of 17, bone lid complications were clearly associated with suture stabilization or no fixation [1,48,53], 2 with rigid fixation methods [4,26], and 3 with resorbable plates [46]; whereas in 10 cases, the fixation method could not be identified [3,9,51]. In Sukegawa et al, different resorbable plates were utilized, and the osteosynthesis material was not found to be related to the bone lid necrosis [46].…”

Biological Effects of Bioresorbable Materials in Alveolar Ridge Augmentation: Comparison of Early and Slow Resorbing Osteosynthesis Materials

“…In general, synthetic pol mer materials can cause a decrease in strength, but this material containing u-HA gua antees sufficient strength when undergoing a special compression molding strengthenin process [6,14]. u-HA/PLLA materials have advantages such as a high biological activit osteoconductivity, biocompatibility, and stable complete degradation [8,12,[15][16][17][18], owin to the presence of uncalcined hydroxyapatite compounds [19]. Furthermore, we observe that u-HA/PLLA had a direct bond with the bone in this study.…”