Modern Concept of Minimally Invasive Treatment of Military Personnel With Mandibular Fracture

Natalia Idashkina (  idashkina@ukr.net ) Dnipropetrovsk Medical Academy of Health Ministry of Ukraine: Dnipropetrovs'ka medicna akademia Ministerstvo ohornoi zdorov'a Ukraini https://orcid.org/0000-0002-3290-4237 Igor Matros-Taranets Ukrainian Military Medical Academy: Ukrains'ka vijs'kovo medicna akademia Оlexandr Gudarian Dnipropetrovsk Medical Academy of Health Ministry of Ukraine: Dnipropetrovs'ka medicna akademia Ministerstvo ohornoi zdorov'a Ukraini Аlla Shepelia Dnipropetrovsk Medical Academy of Health Ministry of Ukraine: Dnipropetrovs'ka medicna akademia Ministerstvo ohornoi zdorov'a Ukraini Hanna Kinchur Dnipropetrovsk Medical Academy of Health Ministry of Ukraine: Dnipropetrovs'ka medicna akademia Ministerstvo ohornoi zdorov'a Ukraini


Background
Over the last decade, there has been an increase of the traumatic injuries, of which mandibular fractures (MF) rank high. The imperfection and costly characteristic of MF treatment methods are sensed by practicing maxillofacial surgeons within the conditions of protracted military con icts in the context of hybrid wars [1]. The specialty of deliver health care in these settings is associated primarily with the fact that hostilities break out in direct proximity to populated locality, residential areas, motorways and other communication routes [2]. The fast-paced combat situation requires an adequate response in the deployment of medical aid stations, and specialized medical care is often provided in medical centers at a distance from the line of army actions [3].
Thus, the patients with MF usually do not receive adequate medical care at the triage stage, which is due to two de ning points: rstly, absolutely justi ed when MF is combined with other severe injuries, an emergency capacity of medical care are provided and immobilization of MF fragments is carried out already in hospital; secondly, patients with MF in a satisfactory condition is rendered a minimal attention at the prehospital stage for saving time, what is especially important in the case of massive injections of wounded men.
Considering the above, the treatment of military servicemen with MF at the hospital stage is an important medical, social and economic problem that requires the health care system resources mobilization. For illustrative purposes, here is a brief abstract of case history. The patient G., 21 years old, MF in the area of 32, 33 teeth (Fig. 1A). On the primary orthopanthogram noted the diastase between the fragments is 5 mm (Fig. 1C). The band splints were applied, manual repositioning and xation with the rubber tractions were performed. However, on the 7th day on the orthopanthogram noted a displacement of fragments (Fig. 1D), mandibular band splint was cut at the level of MF and changed the direction of the rubber traction (Fig. 1B) until the restoration of occlusion (Fig. 1E). ММF with IMF screws also well recommended as an additional method of xation at the gunshot fragment wounds of the mandible with major defects of bone tissue.
As an example, we will give the following clinical case: a volunteer soldier М., 56 years, received a MF as a result of a mine-blast trauma. For the fragment's xation was used the titanium plate; for the adjunctive xation, prevention of fragments convergence and savings of the repaired occlusion was used the ММF with IMF Screws (See Fig. 4, 5, Additional File 1). This tactic allowed for complete rehabilitation of the patient in 6 months; on his own volition, he had served with the Ukrainian military.

Discussion
ММF with IMF screws does not require a wasteful of time and volumetric funding, which is especially important for providing medical care to the maximum number of victims in cases of massive injection [4].
We should pay attention to the advantages of ММF with IMF screws for occlusion adjunctive xation after extensive osteosynthesis and prevents the convergence of fragments [5].

Conclusion
Thus, for the operative treatment of MF in military personnel preference should be given to method of ММF with IMF screws, which provides with the high quality reposition and xation. Availability of data and materials

Abbreviations
The data and materials are all available from this review.

Competing interests
The authors declare that they have no competing interests.

Funding
Not applicable Figure 1 A, B -The interrelationship of mandible fragments before and on the 21st day after the splintage respectively. C, D, E -The orthopanthogram of the jawbones before treatment, on the 7th and 21st day after xation of the standard tape splint respectively Supplementary Files