EVALUASI PENYEMBUHAN FRAKTUR PARASIMFISIS MANDIBULA DENGAN FIKSASI INTERNAL SATU DAN DUA MINIPLATE (Analisis Radiografis dengan Gray Scale Value)

Panji Hendar Rismanto, 2. drg. Poerwati Soetji Rahajoe, Sp.B.M.M., Subsp.T.M.T.M.J.(K), Ph.D ; 3. drg. Pingky Krisna Arindra, Sp.B.M.M, Subsp, Ped, O.M. (K)

2024 | Tesis-Spesialis | S2 Ilmu Bedah Mulut

Perawatan fraktur mandibula bertujuan mengembalikan oklusi, anatomi dan fungsi pengunyahan melalui stabilisasi adekuat. Penggunaan dua miniplate berfungsi menahan gaya tarik dan torsi, namun beresiko mencederai saraf, akar gigi dan biaya tinggi. Modifikasi dengan satu miniplate kombinasi archbar mengurangi resiko pasca operasi dan efisiensi biaya. Tujuan penelitian untuk evaluasi penyembuhan fraktur parasimfisis mandibula pada penggunaan satu miniplate kombinasi archbar, dua miniplate tanpa archbar dan dua miniplate kombinasi archbar menggunakan analisis gray scale value (GSV) yaitu analisis perubahan densitas tulang yang direpresentasikan melalui perubahan derajat keabuan radiograf. Penelitian retrospektif menggunakan data pasien fraktur komplit parasimfisis mandibula unilateral RSUD Margono Soekarjo tahun 2017 sampai 2023 terbagi 3 kelompok, kelompok A: satu miniplate kombinasi archbar, B: dua miniplate tanpa archbar dan C: dua miniplate kombinasi archbar, tiap kelompok 15 pasien. Analisis GSV disajikan dalam pixel value ratio (PVR) yaitu rasio nilai GSV fraktur dengan tulang sehat. Waktu pengamatan 1 hari, 2 minggu, 8-13 minggu dan >13 minggu. Subjek terbanyak laki-laki, rerata usia 25-31 tahun, fraktur didominasi tipe isolated, panjang pelat 5 holes pada ketiga kelompok dengan screw 8 mm paling banyak digunakan. Dari 45 pasien tidak ditemukan mobilitas fraktur, malokluksi dan dehisensi pasca operasi. Parestesi ditemukan pada kelompok B dan C masing-masing  13,3%. Tidak ada perbedaan bermakna nilai GSV dan PVR ketiga kelompok (p=0,855 dan 0,267), kecenderungan nilai tertinggi pada kelompok C. Kesimpulan penelitian ini tidak terdapat perbedaan bermakna nilai GSV dan PVR penggunaan satu miniplate kombinasi archbar, dua miniplate tanpa archbar dan dua miniplate kombinasi archbar pada fraktur komplit parasimfisis mandibula unilateral.

Mandibular fractures treatment goal is to restore occlusion, anatomy and masticatory function through adequate stabilization. The use of two miniplates in the management of mandibular parasymphyseal fractures is to resist tensile and torsional forces, but risks injuring mental nerve, tooth root and higher cost. Modification using one miniplate with an archbar reduces postoperative risk and cost efficiency. This study to evaluate the healing of mandibular parasymphysis fractures in usage of one miniplate with archbar, two miniplates without archbar and two miniplates with archbar using gray scale value (GSV) analysis through bone density analysis during fracture healing which represented in radiograph changing of gray value. his retrospective study using data of complete unilateral mandibular parasymphysis fracture RSUD Margono Soekarjo between years 2017-2023, divided into 3 groups, group A: 1 miniplate with archbar, B: two miniplates without archbar and C: 2 miniplates with archbar with 15 patients per group. GSV analysis was presented in the form of pixel value ratio (PVR), which is the ratio of GSV fracture to healthy bone. Observation time was 1 day, 2 weeks, 8-13 weeks and > 13 weeks. The majority of subjects were males, mean ages 25-31 years, fractures were predominantly isolated type, plate length was 5 holes in the three groups with 8 mm screws most frequently used.From 45 patients no fracture mobility, malocclusion and postoperative dehiscence were found. Paresthesia were found in group B and C which 13.33?ch. There was no significant difference in the GSV and PVR values ??of the three groups (p=0.855 and 0.267), the highest value trend was in group C. The conclusion of this study was that there was no significant difference in the GSV and PVR values ??using one archbar combination miniplate, two miniplates without archbar and two combination miniplates archbar in complete unilateral mandibular parasymphysis fracture.

Kata Kunci : derajat keabuan, fraktur parasimfisis mandibula, miniplate