Surgical Anatomy of the Orbital Skeleton

Abstract

pilot study on 51 consecutive maxillofacial trauma patients requiring the application of IMF using a stainless steel self-tapping, self-drilling IMF screw system (Synthes Maxillofacial, Paoli, PA). The diagnosis, duration of IMF, utilization of screws, screw site, use of elastics and or wires, as well as associated complications were recorded. Patients were selected for inclusion based on their existing occlusion and complexity of injury. IMF screws were used intraoperatively for fracture reduction and post operatively for intermaxillary fixation and guiding elastics. Follow-up examinations were performed weekly or biweekly and extended until fracture healing was deemed clinically complete. The endpoint for this study was the establishment and maintenance of a stable post-operative occlusion. Method of Data Analysis: Data were collected prospectively, and analyzed utilizing the chi-square and Student’s t-test after entry into a nominal spreadsheet. Results: The most common untoward event associated with IMF screw use was screw loosening (7.4%) which occurred equally in the maxilla and mandible. Wire loosening occurred most commonly after two weeks of IMF (6%). Intraoperative complications included tooth root fracture (4%) and screw shearing (4%). Serious complications included the ingestion of hardware in a cognitively impaired patient. There were no malocclusions observed in our follow-ups. The occurrence of an adverse event did not preclude the establishment of a stable post-operative occlusion. Conclusion: Intermaxillary fixation has a wide range of uses in oral and maxillofacial surgery. IMF screws are a safe and facile means of stabilizing the maxillomandibular complex in selected cases. Careful, judicious placement of IMF screws appears to decrease the complication rate. Based on the results of this study, we have developed a protocol to improve the safety profile of intermaxillary fixation screws.