CARTA AL DIRECTOR

Mandibular osteosynthesis failure. Biomechanical and therapeutic considerations. Two clinical cases

Fracaso de la osteosíntesis mandibular. Consideraciones biomecánicas y tratamiento. A propósito de dos casos clínicos

Dear Director

Regarding the discussion of the article: "Failed mandible osteo synthesis. Biomechanical and treatment considerations. A clinical case proposal" that we published in the March-April 2009 edition. We would like to make the following comments:

The author of the discussion used almost two pages of the discussion to refer to definitions and biomechanical concepts that are mentioned identically in the introduction of the article, in fact the same words and definitions were used. We think that this isn't or shouldn't be a topic of discussion.

The author of the commentary provides a table under the heading "Biomechanical SMV Diagram" We appreciate this point however, given that there is no autobiographical reference we are unaware or whether this is the commentator's personal contribution or if it is taken from another author.

In our caseload the number of patients that experienced failed mandible osteo synthesis was less that 1%. Being that this percentage is so low it is safe to say that such cases are infrequent. The author of the commentary says he disagrees but he doesn't provide any other statistic about the incidence that he observed. After looking at the bibliography we still were not able to find any publication that supported the basis of this discrepancy.

In our article we tried to present clinical mandible fracture cases that had poor postoperative evolution and that discussed specific intervention methods to achieve correct consolidation. In the same way as when one reads an article about complications in any procedure, the authors show their bad results, treatment errors and the resources used to achieve, in our case, an acceptable final outcome. We think comments made by the author of this article like: unacceptable, failed strepitous, submissions and suffering of patients, kilograms of antibiotics used, etc. are not the most appropriate when making a case against a project specifically about failed osteo synthesis.

Thank you very much.

I. Navarro Cuellar
Servicio de Cirugía Oral y Maxilofacial. Hospital Universitario "La Paz", Madrid, España