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Clinical research continues to con?rm that no truth is total care of the severely traumatized patient in the ?rst more transitory than that in the sphere of scienti?c hours following the accident. knowledge. Developments in the ?eld of traumatology at The further development of the AO/ASIF concept led the end of this century provide a striking example of to today s comprehensive craniofacial surgery in the this. As early as 1890 Lambotte carried out osteosynthe- ?elds of traumatology,orthognatics,tumor,and rec- ses with plates and screws. These remained a mere epi- structive surgery. sode, however, until Danis renewed the idea of internal AO/ASIF courses contributed fundamentally to the ?xation 50 years later. Danis combined internal ?xation development of these ?elds. In the course of its wor- with the new technique of interfragmentary compres- wide response,the AO/ASIF philosophy has been able to sion,which led to primary bone healing that allowed full attract distinguished authors to join the faculty of function at the same time. Reacting to disconcerting sta- AO/ASIF courses. By sharing their clinical,experim- tistics about the results of conservative fracture treat- tal,and theoretical experience,they take part in shaping ment,Mueller then applied interfragmentary compres- a special internal ?xation technique in the craniofacial sion to 80 patients in Switzerland and con?rmed its use- skeleton. The philosophical aspect of AO/ASIF courses fulness. in theory and practice assures high standards of quality.

Manual of Internal Fixation in the Cranio-Facial Skeleton: Techniques Recommended by the AO/ASIF Maxillofacial Group

1 Scientific Background.- 1.1 Introduction.- 1.1.1 The AO/ASIF Foundation.- 1.1.2 Research.- 1.1.3 Development.- 1.1.4 Education.- 1.1.5 Documentation and Clinical Investigations.- 1.1.6 Fracture Classification.- 1.2 Bone as a Material.- 1.2.1 Structure.- 1.2.2 Chemical Composition.- 1.2.3 Mechanical Properties.- 1.2.4 Mechanical Glossary.- 1.3 Fractures in the Cranio-Maxillo-Facial Skeleton.- 1.3.1 Origin of Skull Bones.- 1.3.2 Load-Bearing Structures in the Cranio-Maxillo-Facial Skeleton.- 1.3.3 The Fracture.- 1.3.4 Biological Reaction and Healing of Bone.- 1.4 Indications for Operative Treatment of Fractures.- 1.5 Operative Reduction and Internal Fixation.- 1.5.1 Reestablishing Stability.- 1.5.2 Implant Materials.- 1.5.2.1 Stainless Steel.- 1.5.2.2 Titanium.- 1.5.2.3 Biodegradable Polymeric Materials.- 1.5.3 Implant Removal.- 1.5.4 Principles of Stabilization.- 1.5.4.1 Splinting.- 1.5.4.2 Compression.- 1.6 Design and Function of Implants and Instruments.- 1.6.1 Screws.- 1.6.1.1 Function of Screws.- 1.6.1.2 Types of Screws.- 1.6.1.3 List of Screws.- 1.6.1.4 Technique of Screw Insertion.- 1.6.1.5 Instruments for Screw Insertion.- 1.6.2 Plates.- 1.6.2.1 Craniofacial Plates.- 1.6.2.2 Mandible and Reconstruction Plates.- 1.6.3 Instruments.- 1.6.4 Power Tools.- 1.7 Set Configurations.- 1.7.1 European Set Configuration.- 1.7.2 North American Set Configuration.- 1.8 External Fixation Devices.- References and Suggested Reading.- 2 Anatomic Approaches.- 3 Mandibular Fractures.- 3.1 Introduction.- 3.2 Treatment Planning.- 3.3 Cost Effectiveness.- 3.4 Adequate Stability.- 3.5 Mistakes in Application and Technique.- 3.6 Failures.- 3.7 Indications for Osteosynthesis.- 3.8 Indications for Perioperative Antibiotic Cover.- 3.9 General Remarks.- 3.10 Localization and Types of Fracture.- 3.11 Fractures of the Symphysis and the Parasymphyseal Area.- 3.11.1 Tr ansverse Fracture Line Without Dislocation.- 3.11.2 Transverse Fracture Line With Dislocation.- 3.11.3 Fracture Line With Basal Triangle.- 3.11.4 Comminuted Fractures.- 3.12 Fractures of the Horizontal Ramus.- 3.12.1 Transverse Fracture Line Without Dislocation.- 3.12.2 Transverse Fracture Line With Dislocation.- 3.12.3 Oblique Fracture Line With/Without Dislocation.- 3.12.4 Fracture Line With Basal Triangle.- 3.12.5 Comminuted Fractures.- 3.13 Fractures of the Mandibular Angle.- 3.13.1 Transverse Fracture Line Without Dislocation.- 3.13.2 Transverse Fracture Line With Dislocation.- 3.13.3 Angular Fractures With Basal Triangle.- 3.13.4 Comminuted Angular Fractures.- 3.13.5 Comminuted Fractures of the Ascending Mandibular Ramus.- 3.14 Condylar and Subcondylar Fractures.- 3.14.1 Transverse Fracture Line With Dislocation.- 3.15 Fractures of the Atrophic Mandible.- 3.16 Infected Fractures.- 3.17 Defect Fractures.- 3.18 Mandibular Fractures in Children.- References and Suggested Reading.- 4 Craniofacial Fractures.- 4.1 Organization of Treatment in Panfacial Fractures.- 4.1.1 Introduction.- 4.1.2 Surgical Sequencing of Le Fort Fracture Treatment.- 4.1.3 Occlusion.- 4.1.4 Upper Face: The Cranial Unit.- 4.1.5 Upper Midfacial Unit.- 4.1.6 Lower Face.- 4.1.7 Linking the Upper and Lower Face.- 4.1.8 Edentulous Fractures.- 4.1.9 Soft Tissue.- 4.1.10 Soft-Tissue Injury.- 4.1.11 The "Double Insult" to Soft Tissue.- References and Suggested Reading.- 4.2 Le Fort I-III Fractures.- 4.2.1 Lower Midface (Le Fort I).- 4.2.1.1 Anatomy.- 4.2.1.2 Classification.- 4.2.1.3 Diagnosis.- 4.2.1.4 Le Fort I Fractures.- Treatment.- Airway Management.- Exposure.- Reduction.- Occlusion.- Fixation.- Bone Grafting.- Palatal Fractures.- Alveolar Ridge.- 4.2.2 Upper Midface (Le Fort II and III).- 4.2.2.1 Anatomy.- 4.2.2.2 Diagnosis.- 4.2.2.3 Treatment.- References and Suggested Reading.- 4.3 Naso-Orbital-Ethmoid Fractures.- 4.3.1 Definition.- 4.3.2 Anatomy.- 4.3.3 Fracture Patterns.- 4.3.4 Plates Used for Internal Fixation of NOE Fractures.- 4.3.5 Exposure.- 4.3.6 Diagnosis.- 4.3.7 Operative Treatment.- 4.3.7.1 Management of Central Fragment.- 4.3.7.2 Transnasal Canthopexy.- 4.3.7.3 Nasal Reconstruction.- 4.3.8 NOE Fracture-Related Problems.- 4.3.8.1 Lacrimal Duct Injuries.- 4.3.8.2 Frontal Sinus.- 4.3.8.3 Skull Base Injuries.- 4.3.8.4 Orbital Reconstruction.- References and Suggested Reading.- 4.4 Zygomatic Complex Fractures.- 4.4.1 Definition.- 4.4.2 Treatment.- 4.4.3 Exposure.- 4.4.4 Reduction.- 4.4.5 Stabilization.- 4.4.6 Internal Orbit.- 4.4.7 Soft-Tissue Closure.- References and Suggested Reading.- 4.5 Orbital Fractures.- 4.5.1 Definition.- 4.5.2 Diagnosis.- 4.5.3 Treatment.- 4.5.4 Reconstruction of Ethmoid Defects.- 4.5.5 Zygomatic (Lateral and Inferior Wall) Injuries.- 4.5.6 Naso-Orbital-Ethmoid Fractures.- 4.5.7 Superior Orbital Rim and Roof Fractures.- References and Suggested Reading.- 4.6 Cranial Vault.- 4.6.1 Frontal Sinus and Frontal Bone.- 4.6.2 Special Conditions Influencing Open Reduction and Internal Fixation.- 4.6.3 Sinus Function and Operative Treatment.- 4.6.4 Types of Fixation.- 4.6.5 Esthetics.- 4.6.6 Osteotomy.- 4.6.7 Exposure.- References and Suggested Reading.- 5 Reconstructive Tumor Surgery in the Mandible.- 5.1 Diagnosis.- 5.2 Patient Selection.- 5.3 Description of Procedures.- 5.3.1 Mandibular Osteotomy.- 5.3.2 Stabilization of Curetted Mandibular Defects.- 5.3.3 Segmental Resection for Benign Tumors.- 5.3.4 Plate Application for Tumors with Extension Through the Anterior Buccal Cortex.- 5.3.4.1 Plate Application for Anterior Tumor Extension Using the Mandible Fix Bridge Device.- 5.3.4.2 Fixation With Miniplates.- 5.3.4.3 Fixation With a Reconstruction Plate.- 5.3.4.4 Three-Dimensional Computer Modeling.- 5.3.5 Application of Bone Grafts Following Bridging Plate Stabilization.- 5.3.6 Reconstruction of Tumor Defects With Vascularized Bone Grafts and Their Fixation With Plates.- 5.3.7 Repair of the Anterior Defect Using a Microvascular Free Bone Flap and Fixation With Universal Fracture Plates (Microvascular Plates), UniLOCK, or Mini Plates.- 5.3.8 Repair of Tumor Defects With Anterior Soft-Tissue Extension with Microvascular Free Bone Flap and Bridging Plate.- 5.3.9 Reconstruction of the Condyle: General Remarks.- 5.3.10 Joint Repair With Costochondral Grafts.- 5.3.11 Alloplastic Replacement of the Condylar Process.- 5.3.12 Condylar Prosthesis for Lateromandibular Defects Including the Joint.- 5.3.13 Management of Mandibular Resection Including the Condyle Using Microvascular Bone Flaps and Various Plates for Fixation.- 5.3.14 Repair of the Lateral Mandible Including the Condyle: Osseous Free Flap and Bridging Plate.- 5.3.15 Repair of the Lateral Mandible and Condyle: Microvascular Free Flap and Reconstruction Plate With Condylar Prosthesis (Schusterman).- 5.3.16 Condylar Reconstruction: Condylar Transplant and Vascularized Bone Flap Reconstruction.- 5.4 Complications.- 5.5 Technical Errors.- 5.5.1 Plate Failure.- 5.5.2 Screw Failure.- 5.5.3 Soft-Tissue Failure.- 5.5.4 Joint Failure.- 5.5.5 Bone Failure.- References and Suggested Reading.- 6 Stable Internal Fixation of Osteotomies of the Facial Skeleton.- 6.1 Introduction.- 6.2 Treatment Planning for Internal Fixation of Osteotomies.- 6.3 Surgical Procedures.- 6.3.1 Mandibular Surgery.- 6.3.1.1 Sagittal Split Osteotomy.- 6.3.1.2 Other Ramus Osteotomies.- 6.3.1.3 Genioplasty.- 6.3.1.4 Mandibular Segmental Surgery.- 6.3.2 Midface Surgery: Le Fort I Osteotomy.- 6.4 Evaluation of Outcomes.- 6.5 Complications.- 6.6 Summary.- References and Suggested Reading.- 7 Craniofacial Deformities.- 7.1 Introduction.- 7.2 Incisions for Craniofacial Reconstruction and Patient Positioning.- 7.3 Craniosynostosis.- 7.4 Planning and Reconstruction.- 7.5 Surgical Technique: Anterior Cranial Expansion and Reconstruction.- 7.6 Posterior Cranial Expansion.- 7.7 Complete or Subtotal Calvarial Expansion.- 7.8 Hypertelorism.- 7.9 Monoblock Osteotomies.- 7.10 Orbital Dystopia.- 7.11 Craniofacial (Hemifacial) Microsomia.- 7.12 The Treacher Collins Malformation.- 7.13 Encephaloceles.- 7.14 Bone Lengthening by Continuous Distraction.- 7.14.1 Distraction for Mandibular Deformities.- 7.14.2 Midface Distraction.- References and Suggested Reading.