Stable Internal Fixation in Maxillofacial Bone Surgery: A Manual for Operating Room Personnel

Functionally stable internal fixation is of particular relevance to maxillo­ facial surgery, because it obviates the discomforts and inconveniences of intermaxillary fixation. Given the biomechanics and biophysics of the skeletal system, the true im­ mobilization of bone can be achieved only through highly technical means. Willenegger speaks of an "advanced school" of bone surgery which, when fully realized, will enable excellent results to be achieved even in the most difficult fractures. To accomplish this goal, ongoing refinements are needed in surgical methods and technology. Advancing the state of operative tech­ nique has been a central concern of the Association for the Study of Inter­ nal Fixation since its establishment 25 years ago. For this reason, a major priority of the AOI ASIF has been to develop its own surgical instrumen­ tation. With the help of technical commissions comprised of experts from medi­ cine, research and manufacturing, the AOI ASIF has been able to develop and successfully test a line of surgical instruments whose trademark is known and respected the world over. For every specialty in traumatology and orthopaedics, including maxillofacial surgery, the AOIASIF has devel­ oped both a basic and a special instrument set designed to meet specific anatomic requirements.

1 General Guidelines for Maxillofacial Internal Fixation.- 1.1 Checklist of General Measures in the Management of Maxillofacial Trauma.- 1.1.1 Initial Management.- 1.1.2 Preparation of the Patient on Admission.- 1.1.3 Postoperative Care.- 1.2 Checklist of General Measures in Orthognathic Maxillofacial Surgery.- 1.2.1 Preoperative Planning and Treatment.- 1.2.2 Preparation of the Patient on Admission.- 1.2.3 Postoperative Care.- 1.3 General Preparations in the Operating Room.- 1.3.1 Recommended Locations of Personnel and Equipment.- 1.3.2 Preparation of Materials.- 1.4 Nomenclature.- 1.4.1 Anatomy of the Skull.- 1.4.2 Anatomy of the Mandible.- 1.4.3 Anatomy of the Dentition.- 1.4.4 Various Drill Bits and Burrs.- 2 Internal Fixation of the Mandible.- 2.1 Indications.- 2.2 Goals.- 2.3 Timing.- 2.4 Diagnosis.- 2.5 Preparation of the Patient on Admission.- 2.6 Preoperative Preparation of the Patient.- 2.7 Instruments and Equipment to be Prepared.- 2.8 Table Setups for Internal Fixation of the Mandible.- 2.8.1 Instruments for Splinting.- 2.8.2 Instruments for Internal Fixation of the Mandible (1st Table).- 2.8.3 Instruments for Internal Fixation of the Mandible (2nd Table).- 2.8.4 Implants for Mandibular Reconstructions.- 2.9 Examples of the Internal Fixation of Various Mandibular Fractures.- 2.10 Operative Procedure.- 2.11 Postoperative Care.- 3 Surgical Treatment of Midfacial Fractures.- 3.1 Indications.- 3.2 Goals.- 3.3 Timing.- 3.4 Diagnosis.- 3.5 Preparation of the Patient on Admission.- 3.6 Preoperative Preparation of the Patient.- 3.7 Instruments and Equipment to be Prepared.- 3.8 Table Setups for Midfacial Fractures.- 3.8.1 Instruments for Splinting.- 3.8.2 Instruments for Internal Fixation of the Maxilla.- 3.8.3 Instruments for Internal Fixation of the Orbit.- 3.8.4 Cranio Fixateur Externe.- 3.9 Use of the Cranio Fixateur Externe for Various Midfacial Fractures.- 3.10 Operative Procedure.- 3.11 Postoperative Care.- 4 Orthognathic Maxillofacial Surgery.- 4.1 Indications.- 4.2 Principle and Goals.- 4.3 Workup Materials that are Taken into Surgery.- 4.4 Preparation of the Patient on the Day Before Surgery.- 4.5 Preoperative Preparation of the Patient.- 4.6 Instruments and Equipment to be Prepared 40.- 4.7 Table Setups for Orthognathic Maxillofacial Surgery.- 4.7.1 Instruments for Splinting.- 4.7.2 Instruments for Orthognathic Maxillofacial Surgery (1st Table).- 4.7.3 Instruments for Orthognathic Maxillofacial Surgery (2nd Table).- 4.7.4 Instruments for Internal Fixation of the Orbit.- 4.7.5 Instruments for Internal Fixation of the Maxilla.- 4.7.6 Cranio Fixateur Externe.- 4.8 Examples of Various Osteotomies.- 4.8.1 Correction Within the Dental Arch.- 4.8.2 Correction Outside the Dental Arch.- 4.9 Operative Procedure.- 4.9.1 Further Procedure for a Segmental Osteotomy.- 4.9.2 Further Procedure for Sagittal Splitting.- 4.9.3 Further Procedure for a Le Fort I Osteotomy.- 4.10 Postoperative Care.- 5 AO/ASIF Instruments for Maxillofacial Bone Surgery.- 5.1 Instruments for 2.7-mm dia. Screws.- 5.2 Instruments for 2.0-mm dia. Screws.- 5.3 General Instruments.- 5.4 Supplementary Instruments.- 5.5 Cranio Fixateur Externe.- 5.5.1 Basic Equipment.- 5.5.2 Additional Devices.- 6 AO/ASIF Implant Set for Maxillofacial Bone Surgery.- 6.1 Screws.- 6.2 Plates.- 7 AO/ASIF Compressed Air Machines.- 7.1 Small Air Drill.- 7.2 Mini Compressed Air Machine and Attachments.- References.