A viable method to replace the metal trocar drill guide in the inaccessibility of the long sagittal drill for mandibular fixation in BSSO

doi:10.21203/rs.3.rs-2248654/v1

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Case Report

A viable method to replace the metal trocar drill guide in the inaccessibility of the long sagittal drill for mandibular fixation in BSSO

https://doi.org/10.21203/rs.3.rs-2248654/v1

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The bilateral sagittal split osteotomy requires many specific instruments. Many of them are not used by any surgical team other than the maxillofacial surgery team. The absence of some of these materials makes it practically impossible to perform or continue the operation, with a negative impact on the outcome. The present report aims to discuss an alternative in cases where long drills for drilling mandibular sagittal osteotomies are not available. An inexpensive method, available in all surgical centers.

Orthognathic surgery

Surgical Instruments

Dentofacial deformities

Osteotomy

Sagittal Split Ramus

Malocclusion

Cosmetics

Humans

Orthognathic surgery is a very common surgical procedure to correct dentofacial deformities for cosmetic and/or functional reasons [1]. And bilateral sagittal split osteotomy (BSSO) is the most usually performed type of osteotomy [2]. It is such a precise and delicate operation, that the lack of some considered simple materials and instruments can often jeopardize the proper course of the operation. Therefore, the purpose of this paper is to report on a replacement that can be performed when long drills for mandibular perforations may not be available.

One patient underwent bimaxillary orthognathic surgery. The maxillary surgery using Le Fort 1 osteotomy was performed without incidents. A bilateral sagittal osteotomy of the mandible was performed, and the bone stumps were mobilized without intercurrences. The surgical guide was positioned and an intermaxillary block was performed. The trocar was inserted into the masseter region. The maxillofacial surgeon (S.S.) requested a long drill for mandibular perforation but there was none in the surgical supplies box. All available drills were evaluated but none were long enough to be used with the trocar. After a few minutes of deliberation and without the slightest possibility of making the perforations with the available material, the surgeon decided on a technical modification.

The surgeon requested a plastic hypodermic needle cap and cut off the tip of the cap after measuring the size of the drills available. Instead of using the trocar to guide the long drill, the needle cap was used to guide and soft tissue protector for a short drill (Fig. 1). According to the surgeon who performed the drills, this technical change was not foreseeable. The only obstacle faced was the lack of adequate surgical retraction in the buccal region, which made it difficult to see the surgical field. Despite this obstacle, there were no difficulties in making the perforations correctly and screwing the osteotomies (Fig. 2). The patient was treated according to the guidelines of Good Clinical Practice and the principles of the Declaration of Helsinki.

Orthognathic surgery is considered to be a very complex maxillofacial surgery. In addition to the surgeon's experience and learning curve, there is material difficulty. Some of the materials used in orthognathic surgery were developed for this purpose [3], others adapted from closely related disciplines such as orthopedics. Some are unique, and not used in other types of maxillofacial surgery. As an example, we can cite among others, basal mandibular reciprocating saws, some retractors, and splitters. Some technical modifications cannot be carried out without the tools developed for this purpose.

No surgical team is free from obstacles related to surgical material or instruments. Human or logistical errors as well as material fatigue can lead to missing material in the transoperative phase. Long drills are among the materials with the highest risk of fracture due to the higher deflection and tensile forces [4]. Fatigue fracture of a drill is associated with repeated use of the same drill. In many cases, the surgical team needs creativity to deal with this sudden lack of material. From this inventiveness for urgency, some tools and techniques emerge [5–7].

Hypodermic needles are everyday materials in the operating room. Inexpensive and readily available, they presented an efficient and a feasible alternative.

In summary, the solution presented by the surgical team was seen as efficient, low-cost, and easily accessible. A viable alternative when there are no long drills for drilling the BSSO.

Ethical approval: This study was approved by the Research Ethics Committee of Mashhad Universuty of Medical Sciences under the number IR.MUMS.REC.1401.247.

Patient consent: Written consent was obtained from the involved patient.

Consent for publication: All authors commented on previous versions of the manuscript, read and approved the final manuscript.

Competing interests: The authors declare no conflict of interests involved in this paper.

Authors contribution: Sahand Samieirad and Masoud Torkzadeh contributed to the study conception and design. Material preparation and data collection were performed by all authors. All authors contributed to draft and final manuscript.

Funding: This research did not receive any commercial association funding, current and within the past five years that might pose a potential, perceived or real conflict of interest. These include grants, patent licensing arrangements, consultancies, stock or other equity ownership, advisory board memberships or payments for conducting or publicizing this study.

Available of data and materials: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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No competing interests reported.

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A viable method to replace the metal trocar drill guide in the inaccessibility of the long sagittal drill for mandibular fixation in BSSO

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