Compact Midface. The systematic solution for craniomaxillofacial indications and displacement osteotomies.

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1 Compact Midface. The systematic solution for craniomaxillofacial indications and displacement osteotomies. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.

2 Image intensifier control This description is not sufficient for immediate application of the instrument set. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to:

3 Table of Contents Introduction Compact Midface 2 Features and benefits 4 AO Principles 5 Intended Use, Indications, Contraindications, General 6 Adverse Events, Device Specific Adverse Events, Warnings, Precautions, and MRI Information Surgical Technique Trauma Repair and Reconstruction 8 Orbital Plates 11 Le Fort I Fixation 13 Product Information Implants 15 Instruments 16 Sets 17 Ordering Information 18 Compact Midface Surgical Technique DePuy Synthes 1

4 Compact Midface The systematic solution for craniomaxillofacial indications and displacement osteotomies. Compact Midface is a highly flexible modular system that consists of a variety of surgical instruments and implants for craniomaxillofacial indications. Key features and benefits Comprehensive solutions based on indications Large selection of titanium plates and meshplates to meet the anatomical needs of the patient Screw diameters in 1.0, 1.3, 1.5 and 2.0 mm available in self-tapping and self-drilling 2.0 mm locking screws for midface Screw clips for quick and easy restocking of screws All implants available in sterile and non-sterile Implant strength and 2.0 Lock 2 DePuy Synthes Compact Midface Surgical Technique

5 Screws Available as self-drilling and self-tapping with two different recesses: PlusDrive Cruciform Screws Overview PlusDrive Cruciform Self-drilling Self-tapping Self-tapping LOCK 2 2 Lag screw 2 System Information System Screw diameter (mm) Drill bit diameter (mm) Emergency screw diameter (mm) Plate thickness (mm) *, 0.76* malleable, malleable, LOCK malleable, 0.9 * Drill bit diameter 0.7 mm for screw lengths: 2 3 mm Drill bit diameter 0.76 mm for screw lengths: 4 8 mm The well thought out design of color-coded screw clips allows the modules to be quickly and easily filled with screws. Compact Midface Surgical Technique DePuy Synthes 3

6 Features and benefits Le Fort I osteotomy Pre-bent maxilla plate 1.5 facitates intraoperative contouring steps Advancements from 3 11 mm Preoperatively determined advancement reliably achieved L, Y, T, and Z Shaped plates L, Y and T plates in various versions and dimensions Z plates in various dimensions with asymmetrical design for secure fixation of the maxilla at the lateral pillars 4 DePuy Synthes Compact Midface Surgical Technique

7 AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation 1,2. They are: Anatomic reduction Fracture reduction and fixation to restore anatomical relationships. A comprehensive implant and instrument selection offers the ability to address most simple and complex fixation needs. Stable fixation Stability by rigid fixation or splintage, as the personality of the fracture and the injury requires. The Compact Midface plates and screws are optimized to achieve stable bone fixation. Preservation of blood supply Preservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques. Early, active mobilization Early and safe mobilization of the part and patient. The Compact Midface system implants, combined with AO technique, provide stable fixation enough to allow a functional aftercare. 1 Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) Manual of Internal Fixation. 3rd, expanded and completely revised ed Berlin, Heidelberg, New York: Springer 2 Rüedi TP, Buckley RE, Moran CG (2007) AO Principles of Fracture Management. 2nd expanded ed Stuttgart, New York: Thieme Compact Midface Surgical Technique DePuy Synthes 5

8 Intended Use, Indications, Contraindications, General Adverse Events, Device Specific Adverse Events, Warnings, Precautions, and MRI Information Intended Use The implants (plates and screws) and their instruments are intended for trauma repair and reconstruction of the craniofacial skeleton. Indications The Compact systems are indicated for selective trauma of the midface and craniofacial skeleton, craniofacial surgery, and orthognathic surgery of the midface. Orbital plates are indicated for trauma repair and reconstruction of the craniofacial skeleton. Specific Indications are: orbital floor fractures, medial orbital wall fractures, and combined orbital floor and medial wall fractures. Contraindications The systems are contraindicated for use in areas with active or latent infection or insufficient quantity or quality of bone. General Adverse Events As with all major surgical procedures, risks, side effects and adverse events can occur. While many possible reactions may occur, some of the most common include: Problems resulting from anesthesia and patient positioning (e.g. nausea, vomiting, dental injuries, neurological impairments, etc.), thrombosis, embolism, infection, nerve and/or tooth root damage or injury of other critical structures including blood vessels, excessive bleeding, damage to soft tissues incl. swelling, abnormal scar formation, functional impairment of the musculoskeletal system, pain, discomfort or abnormal sensation due to the presence of the device, allergy or hypersensitivity reactions, side effects associated with hardware prominence, loosening, bending, or breakage of the device, mal-union, non-union or delayed union which may lead to breakage of the implant, reoperation. Device Specific Adverse Events Device specific adverse events include but are not limited to: Loosening, bending, or breakage of the devices Non-union, mal-union, or delayed union that may lead to breakage of the implants Pain, discomfort, or abnormal sensation due to the presence of the devices Adverse tissue reaction/soft tissue irritation Local infection/systemic infection Damage to vital organs, surrounding structures, and/or soft tissues Peripheral nerve damage Bone damage, bone fracture, and/or bone necrosis User injury Warnings: These devices can break during use (when subjected to excessive forces or outside the recommended surgical technique). While the surgeon must make the final decision on removal of the broken part based on associated risk in doing so, we recommend that whenever possible and practical for the patient, the broken part should be removed. Precaution: Physicians should inform their patients about the implants load restrictions and develop a plan for postoperative behavior and increasing physical loads. 6 DePuy Synthes Compact Midface Surgical Technique

9 MRI Information Magnetic Resonance Environment Torque, Displacement and Image Artifacts according to ASTM F , ASTM F e1 and ASTM F Non-clinical testing of worst case scenario in a 3 T MRI system did not reveal any relevant torque or displacement of the construct for an experimentally measured local spatial gradient of the magnetic field of 5.4 T/m. The largest image artifact extended approximately 20 mm from the construct when scanned using the Gradient Echo (GE). Testing was conducted on a 3 T MRI system. Radio-Frequency-(RF-)induced heating according to ASTM F a Non-clinical electromagnetic and thermal simulations of worst case scenario lead to temperature rises of 9.3 C (1.5 T) and 6 C (3 T) under MRI Conditions using RF Coils (whole body averaged specific absorption rate [SAR] of 2 W/kg for 15 minutes). Precautions: The above mentioned test relies on non-clinical testing. The actual temperature rise in the patient will depend on a variety of factors beyond the SAR and time of RF application. Thus, it is recommended to pay particular attention to the following points: It is recommended to thoroughly monitor patients undergoing MR scanning for perceived temperature and/or pain sensations. Patients with impaired thermoregulation or temperature sensation should be excluded from MR scanning procedures. Generally, it is recommended to use an MRI system with low field strength in the presence of conductive implants. The employed specific absorption rate (SAR) should be reduced as far as possible. Using the ventilation system may further contribute to reduce temperature increase in the body. Compact Midface Surgical Technique DePuy Synthes 7

10 Surgical Technique Trauma Repair and Reconstruction 1 Expose and reduce fracture After completing the preoperative plan, expose the fracture or osteotomy site. In trauma reduce the fracture as required. 2 Select and prepare the implant Select the appropriate plate to the indication. Orient the plate so that the topside is facing out. Cut to length, if necessary. top side bony side Precautions: In order to determine the appropriate amount of screws needed to achieve stable construct fixation, the surgeon should consider the fracture size and shape. Take care to protect soft tissue from trimmed plate edges. Instrument tips may be sharp, handle with care and dispose sharp cuttings in an approved sharps container. 8 DePuy Synthes Compact Midface Surgical Technique

11 3 Contour the plate Contour the plate to fit to the patient anatomy using the plate cutter and bending pliers respectively. Ensure the plate is passively adapted to the bone. Note: An exact match is not required when using locking plates and screws because plate stability is not dependent on plate-to-bone contact when screws are locked. Precautions: If contouring is necessary, the surgeon should avoid bending the device at a screw hole. Avoid sharp bends, repetitive and reverse bending as it increases the risk of implant breakage. Take care to protect soft tissue from trimmed edges. 4 Position the plate Place the plate over the fracture or osteotomy site. Precaution: Confirm that plate positioning, drill bit, and screw length allow for adequate clearance of nerves, tooth buds and/or tooth roots, the edge of the bone, and any other critical structures. Compact Midface Surgical Technique DePuy Synthes 9

12 Trauma Repair and Reconstruction 5 Pre-drilling and screw insertion Pre-drilling is recommended in complex fractures of the midface and in mandibular regions with thick cortical bone. If pilot hole is desired, drill the first hole (for appropriate drill bit diameter, see reference chart on page 3) and insert the first screw close to the fracture or osteotomy site, and tighten until secure. For Cranial Region Fixation, the following precautions apply: In order to determine the appropriate amount of fixation for stability, the surgeon should consider the size and shape of the fracture or osteotomy. DePuy Synthes recommends at least three plates when repairing osteotomies. Additional fixation is recommended to ensure stability of large fractures and osteotomies. When using mesh for larger defects, additional screws for fixation are recommended. Insert the second screw on the opposite side of the fracture or osteotomy site, and then all remaining screws following the outlined procedure. If the screw is inserted with angulation, verify that the screw is safely retained in the plate hole and that the construct profile is not significantly increased. Precautions: Confirm that drill bit length and diameter correspond to selected screw length prior to drilling. Drill speed rate should never exceed 1,800 rpm, particularly in dense, hard bone. Higher drill speed rates can result in: thermal necrosis of the bone, soft tissue burns, an oversized hole, which can lead to reduced pullout force, increased ease of the screws stripping in bone, suboptimal fixation, and/or the need for emergency screws. Avoid damaging the plate threads with the drill. Always irrigate during drilling to avoid thermal damage to the bone and ensure drill bit is concentric to plate hole, irrigation ensures the removal of debris potentially generate during implantation. Take care while drilling as to not damage, entrap, or tear a patient s soft tissue or damage critical structures, nerves or tooth roots. In order to determine the appropriate amount of screws needed to achieve stable construct fixation, the surgeon should consider the fracture size and shape. Confirm screw length prior to implantation. Tighten screws in a controlled manner. Applying too much torque to the screws may cause screw/plate deformation or bone stripping. If bone becomes stripped, remove the screw from the bone and replace with an emergency screw. 11 DePuy Synthes Compact Midface Surgical Technique

13 Surgical Technique Orbital Plates 1 Select plate design Select the appropriate plate shape and thickness that best suits the bony anatomy and treatment objective. 2 Adapt plate to the bone If required, cut and contour the plate to the patient anatomy using the plate cutter and the bending pliers respectively. Ensure that the plate is placed flush to the bone. Precautions: Confirm that plate positioning, drill bit, and screw length allow for adequate clearance of nerves, the edge of the bone, and any other critical structures. Instrument tips may be sharp, handle with care and dispose sharp cuttings in an approved sharps container. If contouring is necessary, the surgeon should avoid bending the device at a screw hole. Avoid sharp bends, repetitive and reverse bending as it increases the risk of implant breakage. Avoid contouring of the implant in situ that may lead to implant malposition and/or posterior cantilever effect. Take care to protect soft tissue from trimmed edges. Compact Midface Surgical Technique DePuy Synthes 11

14 Orbital Plates 3 Drill the hole If pilot hole is desired, select the appropriate diameter drill bit length (see reference chart on page 3) to allow for adequate clearance of nerves, and critical structure. Precautions: Drill speed rate should never exceed 1,800 rpm, particularly in dense, hard bone. Higher drill speed rates can result in: thermal necrosis of the bone, soft tissue burns, an oversized hole, which can lead to reduced pullout force, increased ease of the screws stripping in bone, suboptimal fixation, and/or the need for emergency screws. Avoid damaging the plate threads with the drill. Always irrigate during drilling to avoid thermal damage to the bone. Always irrigate and apply suction during drilling to ensure removal of debris potentially generated during implantation. Note: Self-tapping and self-drilling screws are available (see reference chart on page 3). 4 Fixate plate to the bone Stabilize the implant with screws inserted through selected screw holes in the plate. Insert screws of the appropriate diameter and length to secure the plate to the bone. Precautions: In order to determine the appropriate amount of screws needed to achieve stable construct fixation, the surgeon should consider the fracture size and shape. Confirm screw length prior to implantation. Tighten screws in a controlled manner. Applying too much torque to the screws may cause screw/plate deformation or bone stripping. If bone becomes stripped, remove the screw from the bone and replace with an emergency screw. Note: Test for impingement: A forced duction test must be completed to ensure unrestricted lateral and medial movement of the globe. 11 DePuy Synthes Compact Midface Surgical Technique

15 Surgical Technique Le Fort I Fixation 1 Select plate design After the osteotomy has been performed and the new position of the maxilla has been established, select the appropriate plate shape and thickness that best suits the bony anatomy, treatment objective, and the quantity and quality of bone. 2 Adapt plate to the bone Cut and contour the plate to the bone using the plate cutter and the bending pliers respectively. Ensure that the plate is placed flush to the bone. Precautions: If contouring is necessary, the surgeon should avoid bending the device at a screw hole. Avoid sharp bends, repetitive and reverse bending as it increases the risk of implant breakage. Take care to protect soft tissue from trimmed edges. Confirm that plate positioning, drill bit, and screw length allow for adequate clearance of nerves, tooth buds and/or tooth roots, the edge of the bone, and any other critical structures. Compact Midface Surgical Technique DePuy Synthes 11

16 Le Fort I Fixation 3 Drill the hole If pilot hole is desired, select the appropriate diameter drill bit length (see reference chart on page 3) to allow for adequate clearance of nerves, tooth buds, tooth roots, and critical structure. Note: Self-tapping and self-drilling screws are available (see reference chart on page 3). Precautions: Drill speed rate should never exceed 1,800 rpm, particularly in dense, hard bone. Higher drill speed rates can result in: thermal necrosis of the bone, soft tissue burns, an oversized hole, which can lead to reduced pullout force, increased ease of the screws stripping in bone, suboptimal fixation, and/or the need for emergency screws. Avoid damaging the plate threads with the drill. Always irrigate during drilling to avoid thermal damage to the bone. Always irrigate and apply suction during drilling to ensure removal of debris potentially generated during implantation. 4 Fixate plate to the bone Insert screws of the appropriate diameter and length to fixate the plate to the underlying bone. Precaution: In order to determine the appropriate amount of screws needed to achieve stable construct fixation, the surgeon should consider the fracture size and shape. 11 DePuy Synthes Compact Midface Surgical Technique

17 Implants Midface and cranial plates malleable Orbital floor plates Strut and mesh plates Locking plates Prebent maxilla plates For more information on the implants, please contact your local representative. Compact Midface Surgical Technique DePuy Synthes 11

18 Instruments Standard instruments for the Compact Midface The standard solution contains the basic set of instruments for craniomaxillofacial surgery. For further informations concerning the burr free plate cutter and the three-prong bending pliers see the corresponding flyers ( and ) Individual configuration of instrument trays In addition to the standard model, indivi dually-adapted instrument trays can be assembled. Appropriate and multifunctional inserts are available for the different instruments. 11 DePuy Synthes Compact Midface Surgical Technique

19 Sets Overview: Standard modules Compact Midface The color-coded solution with inserts for implants, screws and instruments. The following pre-configured systems are available: Size 2/3 3/3 Compact 1.0 Midface 2 Compact 1.3 Midface 2 Compact 1.5 Midface 2 Compact 2.0 Midface 2 Compact 2.0 LOCK Midface 2 Compact 2.0 Combi 2 Compact Midface sterile The practical solution for using sterile implants. The module contains rails for snapping in sterile screw clips, and has space for drill bits and screw drivers. The following standard Midface systems are available: Size 1/3 Compact 1.0 Midface 2 Compact 1.3 Midface 2 Compact 1.5 Midface 2 Compact 2.0 Midface 2 Compact 1.5/2.0 Orthognatics The user-friendly module in the standard configuration with inserts for instruments, screw clips and implants in the dimensions 1.5/2.0. In addition, it has pockets for storing screws up to 40 mm long for the lag screw technique. Size 3/3 Compact 1.5/2.0 Orthognatics 2 Compact 1.5/2.0 Orthognatics Plates Compact 1.5/2.0 Orthognatics Screws and Instruments Two modules that belong together when a wide selection of implants and screws is desired. The Screws and Instruments module is also highly suitable for use with sterile implants. Size 2/3 Compact 1.5/2.0 Orthognatics Plates 2 Compact 1.5/2.0 Orthognatics 2 Screws and Instruments Compact Midface Surgical Technique DePuy Synthes 11

20 Ordering Information Compact Midface Compact 1.0 Midface, PlusDrive Compact 1.0 Midface, Cruciform Compact 1.0 Midface, PlusDrive, sterile Compact 1.0 Midface, Cruciform, sterile Compact 1.3 Midface, PlusDrive Compact 1.3 Midface, Cruciform Compact 1.3 Midface, PlusDrive, sterile Compact 1.3 Midface, Cruciform, sterile Compact 1.5 Midface, PlusDrive Compact 1.5 Midface, Cruciform Compact 1.5 Midface, PlusDrive, sterile Compact 1.5 Midface, Cruciform, sterile Compact 2.0 Combi, PlusDrive Compact 2.0 Combi, Cruciform Compact 2.0 Midface, PlusDrive Compact 2.0 Midface, Cruciform Compact 2.0 LOCK Midface, PlusDrive Compact 2.0 Midface, PlusDrive, sterile Compact 2.0 Midface, Cruciform, sterile Plates Adaption Plate 1.3, 6 holes, Adaption Plate 1.3, 8 holes, Adaption Plate 1.5, 6 holes, hole spacing 4.5 mm, Adaption Plate 1.5, 8 holes, hole spacing 4.5 mm, Adaption Plate 1.5, with intersection bars, 4 holes, hole spacing 6.5 mm, Adaption Plate 1.5, with intersection bars, 6 holes, hole spacing 6.5 mm, Adaption Plate 1.5, with intersection bars, 20 holes, hole spacing 6.5 mm, Adaption Plate 2.0, 6 holes, hole spacing 5.0 mm, Adaption Plate 2.0, 8 holes, hole spacing 5.0 mm, Adaption Plate 2.0, with intersection bars, 4 holes, hole spacing 6.5 mm, Adaption Plate 2.0, with intersection bars, 6 holes, hole spacing 6.5 mm, Adaption Plate 2.0, with intersection bars, 18 holes, hole spacing 6.5 mm, Strut Plate 1.0, 6 30 mm, 2 8 holes, thickness 0.5 mm, Strut Plate 1.0, mm, holes, thickness 0.4 mm, Strut Plate 1.0, 6 42 mm, 2 11 holes, thickness 0.5 mm, Strut Plate 1.0, mm, holes, thickness 0.4 mm, Screen Plate 1.0, mm, Adaption Plate 1.0, 34 holes, Orbital Rim Plate 1.0, curved, 11 holes, Orbital Floor Mesh Plate 1.0, thickness 0.2 mm, Orbital Floor Mesh Plate 1.0, thickness 0.3 mm, Orbital Floor Mesh Plate 1.0, thickness 0.4 mm, Anatomic Orbital Floor Plate 1.0, small, Anatomic Orbital Floor Plate 1.0, large, Orbital Floor Plate 1.0, left, Orbital Floor Plate 1.0, right, L-Plate 1.0, left, 9 holes, L-Plate 1.0, right, 9 holes, Y-Plate 1.0, 9 holes, Y-Plate 1.0, 13 holes, 11 DePuy Synthes Compact Midface Surgical Technique

21 Double Y-Plate 1.0, T-Plate 1.0, 10 holes, T-Plate 1.0, 12 holes, X-Plate 1.0, 5 holes, H-Plate 1.0, 6 holes, H-Plate 1.0, 11 holes, Strut Plate 1.3, mm, 8 11 holes, thickness 0.4 mm, Mesh Plate 1.3, mm, thickness 0.4 mm,, blue Mesh Plate 1.3, mm, thickness 0.6 mm,, gold Strut Plate 1.3, mm, holes, thickness 0.4 mm, Mesh Plate 1.3, mm, thickness 0.4 mm,, blue Mesh Plate 1.3, mm, thickness 0.6 mm,, gold Mesh Plate 1.3, mm, thickness 0.6 mm,, gold Adaption Plate 1.3, 24 holes, Orbital Rim Plate 1.3, curved, 9 holes, Plate 1.3, straight, 2 holes, Plate 1.3, straight, 4 holes, Universal Orbital Floor Plate 1.3, Orbital Floor Plate 1.3, left, Orbital Floor Plate 1.3, right, Anatomic Orbital Floor Plate 1.3, small, Anatomic Orbital Floor Plate 1.3, large, L-Plate 1.3, left, 6 holes, L-Plate 1.3, right, 6 holes, L-Plate 1.3, left, 7 holes, L-Plate 1.3, right, 7 holes, Y-Plate 1.3, 5 holes, Double Y-Plate 1.3, short, Double Y-Plate 1.3, long, T-Plate 1.3, 7 holes, Strut Plate 1.3, 8 43 mm, 2 9 holes, thickness 0.5 mm, X-Plate 1.3, 4 holes, H-Plate 1.3, 11 holes, Burr Hole Cover 1.3, for burr holes up to B 17.0 mm, Frame Plate 1.3, rectangular, 4 holes, Frame Plate 1.3, square, 4 holes, Screen Plate 1.3, mm, Orbital Floor Mesh Plate 1.3, thickness 0.2 mm, Orbital Floor Mesh Plate 1.3, thickness 0.3 mm, Orbital Floor Mesh Plate 1.3, thickness 0.4 mm, Zygomatic DCP 2.0, 4 holes, Zygomatic DCP 2.0, 5 holes, Zygomatic DCP 2.0, with centre space, 4 holes, Zygomatic DCP 2.0, 6 holes, Cranial Plate 1.5, straight, with centre space, 4 holes, length 25 mm, Maxilla Plate 1.5, right, prebent, lengthening 3 mm, Maxilla Plate 1.5, left, prebent, lengthening 3 mm, Maxilla Plate 1.5, right, prebent, lengthening 5 mm, Maxilla Plate 1.5, left, prebent, lengthening 5 mm, Maxilla Plate 1.5, right, prebent, lengthening 7 mm, Maxilla Plate 1.5, left, prebent, lengthening 7 mm, Maxilla Plate 1.5, right, prebent, lengthening 9 mm, Compact Midface Surgical Technique DePuy Synthes 11

22 Ordering Information Maxilla Plate 1.5, left, prebent, lengthening 9 mm, Maxilla Plate 1.5, right, prebent, lengthening 11 mm, Maxilla Plate 1.5, left, prebent, lengthening 11 mm, Frame Plate 1.5, square, 4 holes, Adaption Plate 1.5, 20 holes, hole spacing 4.5 mm, Adaption Plate 1.5, 20 holes, thickness 0.6 mm, Orbital Rim Plate 1.5, curved, 8 holes, Orbital Rim Plate 1.5, curved, 10 holes, Orbital Rim Plate 1.5, curved, 12 holes, Universal Orbital Floor Plate 1.5, L-Plate 1.5, left, 5 holes, L-Plate 1.5, right, 6 holes, length mm, L-Plate 1.5, left, 6 holes, length mm, L-Plate 1.5, right, 6 holes, length mm, L-Plate 1.5, left, 6 holes, length mm, L-Plate 1.5, right, 6 holes, length mm, L-Plate 1.5, left, 6 holes, length mm, L-Plate 1.5, right, 5 holes, L-Plate 1.5, right, 5 holes, length mm,, malleable L-Plate 1.5, left, 5 holes, length mm,, malleable L-Plate 1.5, left, 7 holes, L-Plate 1.5, left, 7 holes, length mm,, malleable L-Plate 1.5, right, 7 holes, L-Plate 1.5, right, 7 holes, length mm,, malleable Orbital Rim Plate 2.0, curved, 8 holes, Orbital Rim Plate 2.0, curved, 10 holes, Orbital Rim Plate 2.0, curved, 12 holes, LOCK Plate 2.0, straight, 4 holes, length 20 mm, LOCK Plate 2.0, straight, 6 holes, length 30 mm, LOCK Plate 2.0, small, with centre space, 4 holes, length 28 mm, LOCK Plate 2.0, small, with centre space, 6 holes, length 40 mm, LOCK L-Plate 2.0, right, 7 holes, LOCK L-Plate 2.0, left, 7 holes, LOCK Plate 2.0, straight, with centre space, 2 holes, length 15 mm, LOCK Zygomatic Plate 2.0, straight, with centre space, 4 holes, LOCK Zygomatic Plate 2.0, straight, 4 holes, LOCK Zygomatic Plate 2.0, straight, 5 holes, LOCK Zygomatic Plate 2.0, straight, 6 holes, LOCK Plate 2.0, small, 20 holes, LOCK Orbital Rim Plate 2.0, curved, 8 holes, LOCK Orbital Rim Plate 2.0, curved, 10 holes, LOCK Orbital Rim Plate 2.0, curved, 12 holes, LOCK L-Plate 2.0, right, 5 holes, LOCK L-Plate 2.0, left, 5 holes, 22 DePuy Synthes Compact Midface Surgical Technique

23 LOCK L-Plate 2.0, right, 10 holes, LOCK L-Plate 2.0, left, 10 holes, LOCK Y-Plate 2.0, 5 holes, LOCK Y-Plate 2.0, 8 holes, LOCK Double-Y-Plate 2.0, 8 holes, LOCK T-Plate 2.0, 6 holes, LOCK X-Plate 2.0, 4 holes, LOCK H-Plate 2.0, 9 holes, LOCK T-Plate 2.0, 11 holes, Adaption Plate 2.0, with intersection bars, 30 holes, hole spacing 6.5 mm, L-Plate 2.0, left, 5 holes, L-Plate 2.0, right, 5 holes, L-Plate 2.0, right, 5 holes, length mm,, malleable L-Plate 2.0, left, 5 holes, length mm,, malleable L-Plate 2.0, left, 7 holes, L-Plate 2.0, left, 7 holes, length mm,, malleable L-Plate 2.0, right, 7 holes, L-Plate 2.0, right, 7 holes, length mm,, malleable L-Plate 2.0, left, 10 holes, L-Plate 2.0, long, right, 4 holes,, malleable L-Plate 2.0, long, left, 4 holes,, malleable L-Plate 2.0, right, 10 holes, L-Plate 2.0, left, 4 holes, length mm, Z-Plate 2.0, right, 4 holes, length mm, Z-Plate 2.0, left, 4 holes, length mm, Z-Plate 2.0, right, 4 holes, length mm, Z-Plate 2.0, left, 4 holes, length mm, Z-Plate 2.0, short, right, 4 holes,, malleable Z-Plate 2.0, short, left, 4 holes,, malleable Z-Plate 2.0, long, right, 4 holes,, malleable Z-Plate 2.0, long, left, 4 holes,, malleable Y-Plate 2.0, 5 holes, Y-Plate 2.0, 8 holes, Double Y-Plate 2.0, 8 holes, X-Plate 2.0, 4 holes, H-Plate 2.0, 9 holes, H-Plate 2.0, 8 holes, Adaption Plate 1.5, 20 holes, thickness 0.6 mm,, malleable Y-Plate 1.5, 5 holes, thickness 0.6 mm,, malleable Compact Instruments Standard Instruments Compact Midface Additional Instrument Tray Compact , 3/3, with Lid, without Inserts Insert, 1/3, Insert for Handles, Drill Sleeves, and Holding Instruments, Compact Midface, without Contents Insert, 1/3, for Bending/Cutting Pliers, Compact Midface, without Contents Insert, 1/3, for Instruments Nos and , Compact Midface, without Contents Tray, 1/3, neutral, for Instruments, Compact Midface, without Contents Compact Midface Surgical Technique DePuy Synthes 22

24 Ordering Information Screws: Cortex Screw PlusDrive B 1.0 mm, self-tapping Cortex Screw B 1.0 mm, self-tapping, length 2 mm Cortex Screw B 1.0 mm, self-tapping, length 3 mm Cortex Screw B 1.0 mm, self-tapping, length 5 mm Cortex Screw B 1.0 mm, self-tapping, length 14 mm Cortex Screw PlusDrive B 1.5 mm, self-tapping, Titanium Alloy (TAN) Cortex Screw B 1.5 mm, self-tapping, length 5 mm Cortex Screw B 1.5 mm, self-tapping, length 14 mm Cortex Screw B 1.5 mm, self-tapping, length 16 mm Cortex Screw B 1.5 mm, self-tapping, length 18 mm Cortex Screw PlusDrive B 1.0 mm, self-drilling, Titanium Alloy (TAN) Cortex Screw B 1.0 mm, self-drilling, length 2 mm Cortex Screw B 1.0 mm, self-drilling, length 3 mm Cortex Screw PlusDrive B 1.3 mm, self-tapping Cortex Screw B 1.3 mm, self-tapping, length 3 mm Cortex Screw B 1.3 mm, self-tapping, length 5 mm Cortex Screw B 1.3 mm, self-tapping, length 14 mm Cortex Screw B 1.3 mm, self-tapping, length 16 mm Cortex Screw B 1.3 mm, self-tapping, length 18 mm Cortex Screw PlusDrive B 1.3 mm, self-drilling, Titanium Alloy (TAN) Cortex Screw B 1.3 mm, self-drilling, length 4 mm Cortex Screw B 1.3 mm, self-drilling, length 5 mm Cortex Screw B 1.3 mm, self-drilling, length 6 mm Cortex Screw PlusDrive B 1.5 mm, self-drilling, Titanium Alloy (TAN) Cortex Screw B 1.5 mm, self-drilling, length 4 mm Cortex Screw B 1.5 mm, self-drilling, length 5 mm Cortex Screw B 1.5 mm, self-drilling, length 6 mm Cortex Screw B 1.5 mm, self-drilling, length 8 mm Cortex Screw PlusDrive B 2.0 mm, self-tapping Cortex Screw PlusDrive B 2.0 mm, length 4 mm Cortex Screw PlusDrive B 2.0 mm, length 5 mm Cortex Screw PlusDrive B 2.0 mm, length 6 mm Cortex Screw PlusDrive B 2.0 mm, length 8 mm Cortex Screw PlusDrive B 2.0 mm, length 10 mm Cortex Screw PlusDrive B 2.0 mm, length 12 mm 22 DePuy Synthes Compact Midface Surgical Technique

25 Cortex Screw PlusDrive B 2.0 mm, self-drilling, Titanium Alloy (TAN) Cortex Screw PlusDrive B 2.0 mm, length 4 mm Cortex Screw PlusDrive B 2.0 mm, length 5 mm Cortex Screw PlusDrive B 2.0 mm, length 6 mm Cortex Screw PlusDrive B 2.0 mm, length 7 mm Cortex Screw PlusDrive B 2.0 mm, length 8 mm MF Cortex Screw B 1.0 mm, self-tapping MF Cortex Screw B 1.0 mm, self-tapping, length 2 mm MF Cortex Screw B 1.0 mm, self-tapping, length 3 mm MF Cortex Screw B 1.0 mm, self-tapping, length 4 mm MF Cortex Screw B 1.0 mm, self-tapping, length 5 mm MF Cortex Screw B 1.0 mm, self-tapping, length 6 mm MF Cortex Screw B 1.0 mm, self-tapping, length 7 mm MF Cortex Screw B 1.0 mm, self-tapping, length 8 mm MF Cortex Screw B 1.3 mm, self-tapping MF Cortex Screw B 1.3 mm, self-tapping, length 3 mm MF Cortex Screw B 1.3 mm, self-tapping, length 4 mm MF Cortex Screw B 1.3 mm, self-tapping, length 5 mm MF Cortex Screw B 1.3 mm, self-tapping, length 6 mm MF Cortex Screw B 1.3 mm, self-tapping, length 8 mm MF Cortex Screw B 1.5 mm, self-tapping MF Cortex Screw B 1.5 mm, self-tapping, length 4 mm MF Cortex Screw B 1.5 mm, self-tapping, length 6 mm MF Cortex Screw B 1.5 mm, self-tapping, length 7 mm MF Cortex Screw B 1.5 mm, self-tapping, length 8 mm MF Cortex Screw B 1.5 mm, self-tapping, length 9 mm MF Cortex Screw B 1.5 mm, self-tapping, length 10 mm MF Cortex Screw B 1.5 mm, self-tapping, length 11 mm MF Cortex Screw B 1.5 mm, self-tapping, length 12 mm MF Cortex Screw B 1.5 mm, self-tapping, length 14 mm MF Cortex Screw B 1.5 mm, self-tapping, length 16 mm MF Cortex Screw B 1.5 mm, self-tapping, length 18 mm MF Cortex Screw B 1.5 mm, self-tapping, length 20 mm MF Cortex Screw B 2.0 mm, self-tapping MF Cortex Screw B 2.0 mm, self-tapping, length 4 mm MF Cortex Screw B 2.0 mm, self-tapping, length 6 mm MF Cortex Screw B 2.0 mm, self-tapping, length 8 mm MF Cortex Screw B 2.0 mm, self-tapping, length 10 mm MF Cortex Screw B 2.0 mm, self-tapping, length 12 mm Compact Midface Surgical Technique DePuy Synthes 22

26 Ordering Information Emergency Screws: Emergency Screw PlusDrive B 1.2 mm, self-tapping Emergency Screw B 1.2 mm, self-tapping, length 2 mm Emergency Screw B 1.2 mm, self-tapping, length 3 mm Emergency Screw B 1.2 mm, self-tapping, length 5 mm Emergency Screw B 1.2 mm, self-tapping, length 14 mm Emergency Screw B 1.7 mm, self-tapping, length 3 mm Emergency Screw B 1.7 mm, self-tapping, length 5 mm Emergency Screw B 1.7 mm, self-tapping, length 14 mm Emergency Screw B 1.7 mm, self-tapping, length 16 mm Emergency Screw B 1.7 mm, self-tapping, length 18 mm Emergency Screw B 2.0 mm, self-tapping, length 14 mm Emergency Screw B 2.0 mm, self-tapping, length 16 mm Emergency Screw B 2.0 mm, self-tapping, length 18 mm Emergency Screw PlusDrive B 2.4 mm, self-tapping Emergency Screw PlusDrive B 2.4 mm, length 5 mm Emergency Screw PlusDrive B 2.4 mm, length 6 mm Emergency Screw PlusDrive B 2.4 mm, length 8 mm Emergency Screw PlusDrive B 2.4 mm, length 10 mm Emergency Screw PlusDrive B 2.4 mm, length 12 mm Emergency Screw PlusDrive B 2.4 mm, length 14 mm Emergency Screw PlusDrive B 2.4 mm, length 16 mm Emergency Screw PlusDrive B 2.4 mm, length 18 mm Emergency Screw Cruciform Recess B 1.2 mm, self-tapping Emergency Screw B 1.2 mm, self-tapping, length 2 mm Emergency Screw B 1.2 mm, self-tapping, length 3 mm Emergency Screw B 1.2 mm, self-tapping, length 4 mm Emergency Screw B 1.2 mm, self-tapping, length 5 mm Emergency Screw B 1.2 mm, self-tapping, length 6 mm Emergency Screw B 1.2 mm, self-tapping, length 7 mm Emergency Screw B 1.2 mm, self-tapping, length 8 mm Emergency Screw Cruciform Recess B 1.7 mm, self-tapping Emergency Screw B 1.7 mm, self-tapping, length 3 mm Emergency Screw B 1.7 mm, self-tapping, length 4 mm Emergency Screw B 1.7 mm, self-tapping, length 5 mm Emergency Screw B 1.7 mm, self-tapping, length 6 mm Emergency Screw B 1.7 mm, self-tapping, length 8 mm 22 DePuy Synthes Compact Midface Surgical Technique

27 Emergency Screw B 2.4 mm, self-tapping Emergency Screw B 2.4 mm, self-tapping, length 6 mm Emergency Screw B 2.4 mm, self-tapping, length 8 mm LOCK Screw PlusDrive B 2.0 mm, self-tapping LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 5 mm, Titanium Alloy (TAN) LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 6 mm, Titanium Alloy (TAN) LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 8 mm, Titanium Alloy (TAN) LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 10 mm, Titanium Alloy (TAN) LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 12 mm, Titanium Alloy (TAN) LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 14 mm, Titanium Alloy (TAN) LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 16 mm, Titanium Alloy (TAN) LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 18 mm, Titanium Alloy (TAN) LOCK Screw PlusDrive B 2.0 mm, self-drilling LOCK Screw PlusDrive B 2.0 mm, self-drilling, length 5 mm LOCK Screw PlusDrive B 2.0 mm, self-drilling, length 6 mm LOCK Screw PlusDrive B 2.0 mm, self-drilling, length 8 mm Ordering Information* Screws Plates Packs of 1 unit xxx.xxx xxx.xxx Packs of 1 unit with clip xxx.xxx.01c n/a Packs of 4 units with clip xxx.xxx.04c n/a Packs of 1 unit, sterile n/a xxx.xxxs Packs of 1 unit with clip, sterile xxx.xxxs n/a Packs of 4 units with clip, sterile xxx.xxx.04s n/a * Not all packaging variatons are available for all items. Compact Midface Surgical Technique DePuy Synthes 22

28 DSEM/CMF/0316/ /16 Synthes GmbH Eimattstrasse 3 Not all products are currently available in all markets Oberdorf Switzerland This publication is not intended for distribution in the USA. Tel: Fax: All surgical techniques are available as PDF files at DePuy Synthes CMF, a division of Synthes GmbH All rights reserved

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