Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable? (original) (raw)
Related papers
Oral and Maxillofacial Surgery, 2018
Purpose Intermaxillary fixation (IMF) is a fundamental principle in the management of mandibular fractures but with recent advent of open reduction and internal fixation (ORIF), use of IMF is almost limited intraoperatively. Therefore, we compared the efficacy of Erich arch bar versus embrasure wires for intraoperative IMF in mandibular fractures. Method This prospective study was comprised of 50 patients with mandibular fractures who required ORIF with intraoperative IMF. Patients were categorized into two groups of 25 patients each: Erich arch bar technique was used for group A and embrasure wire technique for group B. Parameters were time taken for IMF, needle stick injury, occlusal stability, iatrogenic complications, and periodontal status of patients. Statistical analysis Chi-squared test and unpaired t test analyses was run on IBM SPSS 21.0 version (2015) software. Result Mean time for placing embrasure wire (3.48 min) was significantly less than that for Erich arch bar (48.08 min). Needle stick injury rates to the operator as well as the assistants were significantly less when using the embrasure wire than the Erich arch bar. The Erich arch bar had significantly superior postoperative occlusion stability. Iatrogenic injury was more common when placing the Erich arch bar than the embrasure wire. Postoperative oral hygiene status was good in patients that received the embrasure wire. Conclusion Embrasure wire technique is a quick, easy, and reliable technique for minimally or moderately displaced fractured mandible and had better clinical outcomes than did patients that underwent the Erich arch bar technique. Keywords IMF (intermaxillary fixation). MMF (maxillomandibular fixation). ORIF (open reduction and internal fixation). OHI-S (oral hygiene index (simplified))
Journal of Maxillofacial and Oral Surgery, 2017
Introduction Maxillomandibular fixation is required in nearly all cases of facial fractures which can be achieved by conventional dental wiring techniques or newer methods using transalveolar screws. Material and Methods A prospective randomized clinical study divided into two groups with thirty adult patients each with mandibular fractures was undertaken comparing the Maxillomandibular fixation technique using transalveolar screws and Erichs arch bar. Total time taken, rate of glove perforation, intraoperative and postoperative complications were noted in both the groups. Results The time taken for maxillomandibular fixation in minutes and rate of glove perforation was found to be statistically significantly less for transalveolar group compared to arch bar group (p \ 0.05). However, there was no significant difference found in the oral hygiene and gingival status using the Glass index and Gingival index. The rate of screw breakage (04.67%), wire breakage (05.12%), non-vitality due to iatrogenic dental damage (01.66%), soft tissue injury and tooth loss were some of the noted complications during the study. Conclusion We found that transalveolar group offered advantages like less time taken with a definite decreased risk of percutaneous injury, while the iatrogenic complications like dental damage can be reduced by taking adequate precautions.
Annals of Maxillofacial Surgery, 2021
Mandibular fractures remain the most common facial fractures encountered. The treatment of mandibular fractures can be accomplished with either closed treatment or open reduction-internal fixation (ORIF). Maxillomandibular fixation (MMF) can be defined as any method used to secure the maxilla and mandible to each other into the appropriate dental occlusion. It is a standard component of the treatment of mandibular fracture where it is required for closed treatment and for most of ORIF cases. The three main principles of MMF are to establish occlusion, provide stability, and immobilize the jaws. [1] Several techniques have been described for MMF including but not limited to arch bars, interdental eyelet wiring, bonded brackets, embrasure wires, Ernst ligatures, and external pin fixation. However, the placement of Erich arch bars (EABs) fixated to the dentition with circumdental stainless steel wires has been the standard practice for MMF for or during the repair of mandibular fractures for many decades. [2] Most of these techniques are limited in the setting of poor dentition or in patients who are partially edentulous, in addition of being time-consuming, and are associated with risks of mucosal, dental, and needlestick injuries.
International Journal of Pharmaceutical and Biological Science Archive, 2021
Introduction: Occlusion is the way in which one's maxillary and mandibular teeth relate to each other when the jaw is closed. When treating fractures of the mandible, the first and primary objective is to re-establish the patient's premorbid occlusion which is required for the mastication and also the other objective is to achieve esthetics. Inter-maxillary fixation (IMF) plays a vital role in management of fractures involving maxilla and mandible & helps in stabilizing the patient's occlusion and thus reduction in fracture segments.
Journal of Oral and Maxillofacial Surgery, 2014
The aim of the present randomized study was to evaluate the efficacy of intermaxillary fixation screw (IMFS) versus eyelet interdental wiring for intermaxillary fixation (IMF) in minimally displaced mandibular fractures. Materials and Methods: A total of 50 patients with a minimally displaced mandibular fracture were enrolled, with 25 patients randomly selected for each group. In group I (study group, n = 25), the patients were treated using IMFS, and in group II (control group, n = 25), they received eyelet interdental wiring. Both techniques were assessed for the following parameters: time required for placement and removal of each type of IMF technique, time required for placement of IMF wires, postoperative occlusion, stability of the IMF wire, local anesthesia requirement during removal of each fixation type, oral hygiene status, glove perforation rate, and complications associated with both techniques. The collected data were analyzed using Student's unpaired t test or c 2 test. P < .05 was considered significant and the Statistical Package for Social Sciences software, version 10, was used for analysis. Results: The average time required for placement in groups I and II was 17.56 and 35.08 minutes, respectively (P = .000). The time required for placement of the IMF wire in group I was 2.1 minutes and in group II was 6 minutes. The oral hygiene status was assessed, and the mean plaque index score for groups I and II was 1.44 and 2.12, respectively (P = .00). The glove perforation rate was much less in group I than in group II. Finally, the most common complication in both groups was mucosal growth. Conclusions: The results established the supremacy of IMFS compared with eyelet interdental wiring. Thus, we have concluded that IMFS, in the present scenario, is a safe and time-saving technique. IMFS is a cost-effective, straightforward, and viable alternative to cumbersome eyelet interdental and other wiring techniques for providing IMF, with satisfactory occlusion during closed reduction or intraoperative open reduction internal fixation of fractures. In addition, oral hygiene can be maintained, and the glove perforation rate was very low using IMFS. The relatively small sample size and limited follow-up period were the study limitations.
Biomedical and Pharmacology Journal, 2017
The application of tooth supported appliances of various types to the jaws and immobilization by intermaxillary fixation is the customary form of treatment in the management of fracture of the mandible and maxilla. Wire ligatures, arch bars and splints aide in the treatment of jaw fractures. They are applied to the teeth, alveolar processes and skeletal parts of the face or cranium. They function in the fixation of injured skeletal parts among one another and to the uninjured portions as well as the immobilization of fractured or loosened teeth. To Compare Arch Bar, Eyelets and Transmucosal Screws for Maxillomandibular Fixation in Jaw Fractures. Various modalities such as wire ligatures, arch bars and splints have been recommended but they have their associated morbidity including periodontal damage, decalcification under the splints and loosening and extrusion of the supporting teeth. 36 patients requiring maxillomandibular fixation who had jaw fractures are divided into three groups (arch bar, eyelets and transmucosal screws) the duration maxillomandibular fixation is 3-4 weeks. The plaque accumulation index (primary outcome) showed significant difference between all three groups. Mucosal damage time of fixation and time of removal (secondary outcome) showed significant between all three groups. For our study of maxillomandibular fixation comparing all three groups transmucosal screws has significantly less plaque accumulation less traumatic and less operating time.
A novel approach towards Maxillo-mandibular fixation going past Erich arch bar technique
IOSR Journals , 2019
Background: Maxillo-mandibular fixation (MMF) establishes dental occlusion for the treatment of mandible and maxilla fractures. The present study was conducted to assess cases of MMF cases using Dental ties. Materials & Methods: The present study was conducted in the department of Oral & maxillofacial surgery in Dr Guru Eye and Dental Surgical centre. It comprised of 20 adult patients of maxillofacial fracture of both genders. MMF was performed using dental Ties. Fracture types, operating room time, dental occlusion, Dental ties application times, number of ties used per patient and device failures were recorded. Results: Out of 20 patients, males were 12 and females were 8. Most common fracture was Parasymphyseal (7) followed by Left subcondylar (5), right body (4), right angle (3) and Lefort I & II (1). The difference was significant (P<0.05). The mean application time in males was 25.4 minutes in males and 30.5 minutes in females, mean ties used was 10.4 in males and 12.2 in females, failure was needle break 1 in male and female, ties flossed out in 1 female and needle break at swedge in 2 males. The difference was significant (P<0.05). Conclusion: Authors suggested that dental tie is proved to be the novel and most feasible option next to MMF. There were less failure rates in present study.
Objective: To evaluate the archbar as a tensioning band compared to the tension band plate, providing an alternative technique for mandibular osteosynthesis to reduce implant material and minimize implant-related postoperative complications. Methods: The study included open reduction and internal fixation (ORİF) in eighty patients with mandibular fractures and two groups of mini-plates and screws. Group A treated with Two plates fixation group B were treated with the one plate fixation with tension strips by anarchbar in the second plate to ensure effective balancing of the fracture sections. Most of these patients were treated with local anesthesia. Postoperative complications were lower in Group-B than Group-A, preferring to use a archbar as a tension band. To defeat the torsional forces generated in the front of the mandible body during the function. Results: Infection was the postoperative complication in (7.5%), 5% in Group A and 2.5% in Group B, and the other complications in Group A included 5% malocclusion and extraction. No such complication was found in 10% of the plate and 10% in the B group. Conclusion: Osteosynthesis with both techniques was effective to provide an immediate postoperative function, but complications in Group B were few.
The Hybrid Arch Bar Is a Cost-Beneficial Alternative in the Open Treatment of Mandibular Fractures
Craniomaxillofacial Trauma & Reconstruction
Obtaining maxillomandibular fixation (MMF) to achieve fracture reduction and functional occlusion is essential in the management of maxillofacial trauma. The aims of this retrospective review were to compare the total time spent in the operating room (OR) when using the Erich arch bar (EAB) versus the bone anchored hybrid arch bar (HAB) as well as performing a cost–benefit analysis (CBA). The study sample comprised patients older than 18 years who underwent open reduction internal fixation of mandible fractures at two separate institutions over a 5-year period. The primary outcome variable was total surgical time in minutes, defined as the time from incision to the completion of closure. Average operative time was significantly longer for the EAB than for the HAB (186.74 ± 70.73 vs. 135.98 ± 2.69 minutes, p < 0.001). A significant amount of time was saved by using the HAB for unilateral (37.17 ± 13.19 minutes; p = 0.007) and bilateral fractures (55.83 ± 18.89 minutes; p = 0.005)....
Interventions for the management of mandibular fractures
Cochrane Database of Systematic Reviews, 2013
Fractures of the mandible (lower jaw) are a common occurrence and usually related to interpersonal violence or road traffic accidents. Mandibular fractures may be treated using open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized with intermaxillary fixation (IMF) or other external or internal devices (i.e. plates and screws) to allow bone healing. Various techniques have been used, however uncertainty exists with respect to the specific indications for each approach. Objectives The objective of this review is to provide reliable evidence of the effects of any interventions either open (surgical) or closed (nonsurgical) that can be used in the management of mandibular fractures, excluding the condyles, in adult patients. Search methods We searched the following electronic databases: the Cochrane Oral Health Group’s Trials Register (to 28 February 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE via OVID (1950 to 28 February 2013), EMBASE via OVID (1980 to 28 February 2013), metaRegister of Controlled Trials (to 7 April 2013), ClinicalTrials.gov (to 7 April 2013) and the WHO International Clinical Trials Registry Platform (to 7 April 2013). The reference lists of all trials identified were checked for further studies. There were no restrictions regarding language or date of publication. Selection criteria Randomised controlled trials evaluating the management of mandibular fractures without condylar involvement. Any studies that compared different treatment approaches were included. Data collection and analysis At least two review authors independently assessed trial quality and extracted data. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated to include both clinical and methodological factors. Main results Twelve studies, assessed as high (six) and unclear (six) risk of bias, comprising 689 participants (830 fractures), were included. Interventions examined different plate materials and morphology; use of one or two lag screws; microplate versus miniplate; early and delayed mobilization; eyelet wires versus Rapid IMF™ and the management of angle fractures with intraoral access alone or combined with a transbuccal approach. Patient-oriented outcomes were largely ignored and post-operative pain scores were inadequately reported. Unfortunately, only one or two trials with small sample sizes were conducted for each comparison and outcome. Our results and conclusions should therefore be interpreted with caution. We were able to pool the results for two comparisons assessing one outcome. Pooled data from two studies comparing two miniplates versus one miniplate revealed no significant difference in the risk of postoperative infection of surgical site (risk ratio (RR) 1.32, 95% CI 0.41 to 4.22, P = 0.64, I2 = 0%). Similarly, no difference in postoperative infection between the use of two 3-dimensional (3D) and standard (2D) miniplates was determined (RR 1.26, 95% CI 0.19 to 8.13, P = 0.81, I2 = 27%). The included studies involved a small number of participants with a low number of events. Authors’ conclusions This review illustrates that there is currently inadequate evidence to support the effectiveness of a single approach in themanagement of mandibular fractures without condylar involvement. The lack of high quality evidence may be explained by clinical diversity, variability in assessment tools used and difficulty in grading outcomes with existing measurement tools. Until high level evidence is available, treatment decisions should continue to be based on the clinician’s prior experience and the individual circumstances