Objective. The aim of this study was to assess the safety and efficiency of biodegradable self-reinforced (SR-PLDLA) bone plates and screws in open reduction and internal fixation of mandible fractures in children.Study design. Thirteen patients (5 female, 8 male; mean age 12 years, range 5-16 years) were operated on various fractures of the mandible (2 symphyseal, 6 parasymphyseal, 4 body, 3 angle, I ramus, 2 condylar fractures). The mean follow-up time was 26.4 months (range 10.9-43.4 months). intermaxillary fixation was applied in cases with concomitant condylar fractures up to 3 weeks.Results. Primary healing of the fractured mandible was observed in all patients. Postoperative complications were minor and transient. The outcome of the operations was not endangered. Adverse tissue reactions to the implants, malocclusion, and growth restrictions did not occur during the observation period.Conclusions. Pediatric patients benefit from the advantages of resorbable materials, especially from faster mobilization and the avoidance of secondary removal operations. Based on these preliminary results, self-reinforced fixation devices are safe and efficient in the treatment of pediatric mandible fractures. However, further clinical investigations are necessary to evaluate the long-term reliability.

BACKGROUND:Biodegradable implants have not been used on a large scale for internal fixation of mandibular fractures because of presumed inferior mechanical properties. This prospective clinical trial was designed to elucidate the stability and biocompatibility of self-reinforced poly-L/D-lactide plates and screws used to stabilize a variety of mandible fractures by open reduction and internal fixation. METHODS:Sixty-six consecutive patients (22 female, 44 male; mean age, 23.9 years) with a total of 89 fractures at various sites of the mandible were included in the study. Stability of plates and screws and bone healing were observed by clinical and radiographic assessment. Intermaxillary fixation was applied in eight patients with concomitant condylar fractures for 2 to 3 weeks. RESULTS:The self-reinforcement technique provided sufficient mechanical stability of the implants for primary healing of these high-load mandibular bone areas. Postoperative complications were transient and limited to wound dehiscence and localized wound infection (two patients). In some patients, hypesthesia (three patients) or slight pain (10 patients) was reported at the 1-year recall examination, but implant-related serious adverse tissue reactions were not observed during the follow-up (mean, 24.4 months; range 6.4 to 44.3 months). CONCLUSIONS:On the basis of these preliminary results, the authors conclude that biodegradable self-reinforced implants show efficient stability during initial bone healing and promise a high potential for successful use in osteofixation of mandibular fractures.

The study was performed to evaluate abdominal complications related to jejunal segment resection for reconstruction after radical oropharyngeal tumor resection. Perioperative complications of 104 patients (median age, 53.7 years; 23 female; 81 male) who underwent surgery for oropharyngeal malignancy after radiochemotherapy and the long-term morbidity of 35 patients after a median follow-up period of 21 months are analyzed. The perioperative mortality was 8.7% (9/104); none of the perioperative deaths was caused by an abdominal complication associated with the jejunal resection. In three cases, repeat laparotomy was performed within 30 days of jejunal autotransplantation: in two of them the reason was not directly associated with bowel resection and one patient had an abdominal wall dehiscence. In six cases there were minor abdominal complications which could be treated nonsurgically. There was no anastomotic leakage, bowel obstruction or postoperative bleeding. In the follow-up re-examination, no late onset abdominal complications were noted except small incisional hernias in six of the 35 patients; only one required a hernia repair. Despite a potentially increased operative risk in these patients, the complication rate after bowel resection for jejunal autotransplantation was low. This is a safe procedure in patients with oropharyngeal carcinoma.

Grundlagen: Das Metastasierungsverhalten von Plattenepithelkarzinomen der Mundhöhle und des Oropharynx ist ein entscheidender Faktor in der Prognose. Im Rahmen der chirurgischen Behandlung der regionären Lymphknoten stehen verschiedene Formen der Dissektion und En-bloc-Resektion zur Verfügung.

Reconstruction after radical tumor resection in the oropharyngeal region still represents an interdisciplinary challenge. Autotransplantation of the jejunum is a popular procedure, in which the abdominal surgeon's main task is that of harvesting enteral tissue. To evaluate this technique, a careful analysis of accompanying perioperative abdominal complications was performed. Additionally, we reexamined 35 of 66 patients still living after a follow-up period of 21 (range 2-63) months on average. The perioperative mortality of 90 patients treated for oropharyngeal malignancy using the described procedure was 7.8%. None of the perioperative deaths was caused by an abdominal complication associated with enteral resection. One abdominal reoperation was performed because of abdominal wall dehiscence. For reasons not related to enteral resection, four further patients had to be relaparotomized, two of them during their hospital stay and two after leaving hospital. In five cases we observed minor complications which could be treated nonsurgically. In the followup reexamination we detected no abdominal late-onset complication except small incisional hernias in six cases. Finally, we concluded that despite an elevated overall operative risk in this population, complications owing to jejunal resection were comparably low. The data regarding the rate of complications classify jejunal resection as a safe procedure for reconstructive purposes in patients suffering from oropharyngeal malignancy.