Use of needle cover as a trocar for removal of an infected implant: a novel minimal invasive approach
Prathamesh Bhujbal, Sonal Shah
, Sneha Setiya
Contributions: (I) Conception and design: P Bhujbal; (II) Administrative support: None; (III) Provision of study materials or patients: S Shah; (IV) Collection and assembly of data: S Setiya; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Abstract: Mandibular fractures are common sequelae of road traffic accidents, assaults and pathologic fractures. Treatment for fractures is rigid internal fixation for complete and complex fractures. Most effective miniplates and screws are used as they are load shearing as well as load bearing rigid fixation. Most of the fractures in the maxillofacial regions are treated with intraoral approaches to avoid extraoral scars. Also, after 1 year many patients may want to get the hardware removed for various reasons like pain, prosthetic rehabilitation, plate exposure, screw loosening, infection or simply patient’s demand. We had a patient of infective implants (3D strut plate) in mandibular angle (history of trauma 1 year ago) where two screws were not accessible through the intraoral approach. Since the transbuccal kit was not available, a sterile needle cover was used as a trocar through transbuccal approach for inaccessible screws which were then retrieved using a screw driver through the needle cover. Needle cover can be used as a rescue option in the need of the hour for surgeons in absence of transbuccal kit in emergency situation. Although this technique is very useful, we recommend it as an emergency module and not as a replacement to the traditional transbuccal kit.
Keywords: Trocar; rigid internal fixation; alternative to trocar; needle cap
Received: 13 October 2022; Accepted: 18 January 2024; Published online: 09 May 2024.
doi: 10.21037/fomm-22-54
Highlight box
Surgical highlights
• Use of needle cover as canula.
What is conventional and what is novel/modified?
• In cases of difficulty in access and absence of conventional transbuccal kit, we can use needle cover as a cannula.
What is the implication, and what should change now?
• Although needle cover cannot replace the traditional transbuccal kit, it can be useful in need of the hour.
Technical note
Mandibular fractures are common occurrences in road traffic accidents, assaults and extensive pathology. After osteosynthesis of mandibular fractures, hardware removal may be indicated due to various reasons, such as prosthetic rehabilitation, plate exposure, screw loosening, infection or simply patient’s demand (1). Most mandibular fracture fixations are done intra-orally except in condylar fractures or if extraoral laceration or scar is present. Use of trocar helps to avoid larger external incisions by placing single stab incision. We have used a sterile needle cover as a substitute to the traditional trans-buccal kit. After confirmation of mandibular fracture healing through radiographs, a patient was scheduled for surgical removal of an infective hardware. This was an angle fracture treated one year before with a 3D Strut plate with 2 mm screws (2) (Figure 1). The plate and screws were exposed intraorally and removed. Two screws were not accessible intraorally. Therefore, trans-oral approach was planned. Due to absence of trans-buccal kit we planned to use a sterile needle cover as trocar (Figure 2). A stab incision was made through the existing scar ensuring the safety zone for trans-buccal approach (3). The two screws were then retrieved using a driver through the needle cover via trans-buccal approach (Figures 3-5). Third molar, second molar and an impacted supernumerary tooth were removed intraorally and closure was done using 4-0 vicryl and 5-0 prolene extraorally. Postoperative orthopantomogram was obtained (Figure 6). Baliga and Urolagin have used needle cover in the treatment of naso-orbito-ethmoidal fractures (4). We have not encountered any drawbacks with use of the needle cover as a trocar for trans-buccal approach. Its length is about 5.5 cm and its diameter is 0.5 cm which is sufficient for the entry of a screw driver and 1.5 mm drill bit to pass through.
Conclusions
This technique results in a smaller scar as compared to the trocar and provides gateway technique as a rescue option for surgeons in absence of trans-buccal kit in an emergency situation. However, we do not recommend it as a replacement to the trans-buccal kit.
Acknowledgments
Funding: None.
Footnote
Peer Review File: Available at https://fomm.amegroups.com/article/view/10.21037/fomm-22-54/prf
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://fomm.amegroups.com/article/view/10.21037/fomm-22-54/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this article and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
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- Bhujbal P, Rao SK, Waknis P. Patient End of Endotracheal Tube as Gateway for Transbuccal Approach in Internal Fixation of Mandibular Angle Fracture: A Technical Note. J Maxillofac Oral Surg 2022;21:452-3. [Crossref] [PubMed]
- Gulses A, Kilic C, Sencimen M. Determination of a safety zone for transbuccal trocar placement: an anatomical study. Int J Oral Maxillofac Surg 2012;41:930-3. [Crossref] [PubMed]
- Baliga SD, Urolagin SB. Transnasal Fixation of NOE Fracture: Minimally Invasive Approach. J Maxillofac Oral Surg 2012;11:34-7. [Crossref] [PubMed]
Cite this article as: Bhujbal P, Shah S, Setiya S. Use of needle cover as a trocar for removal of an infected implant: a novel minimal invasive approach. Front Oral Maxillofac Med 2025;7:16.
