[Preoperative planning and function-stable fixation by osteosynthesis and external cranial clamp in the treatment of...

Close collaboration between the orthodontist and the surgeon is essential to the success of any corrective maxillofacial procedure. The operative part combines the surgical principles of orthopedics with those of dentistry. However, until recently little emphasis was placed on truly stable fixation of the maxillofacial segments following osteotomy; they were simply wired together and then immobilized by intermaxillary fixation and traction. The stabilization of osteotomies of the long bones by internal fixation with plates and screws or by the application of external fixation clamps has been accepted orthopedic surgical practice for a number of years. The Association for the Study of Internal Fixation (ASIF) has played an important part in the development of these techniques. The principles involved are now being applied to the fixation of maxillofacial osteotomies. Devices such as lag screws, the EDCP, mandibular reconstruction plate, and the "craniofixature externe" are being used to obtain functionally stable fixation, thus eliminating the need for traction. If the upper and lower jaws are to be operated on simultaneously then functionally stable fixation is an essntial prerequisite for accurate displacement by the amount, and in the direction, planned. The introduction of rigid stabilisation techniques into the field of maxillofacial surgery has led to an increased emphasis on accurate preoperative planning. It is important that the surgeon performs the key steps of the preoperative planning, such as simulography, himself. This involves little extra work, since the computational and graphic chores are nowadays performed by the computer.