Arch Bar Research Articles

Maxillomandibular Fixation: Understanding the Risks and Benefits of Contemporary Techniques in Adults.

Numerous techniques achieve maxillomandibular fixation (MMF), each with benefits and risks. While using Erich arch bars to achieve MMF has remained the gold standard through the last century, the technique has multiple limitations, which have spurred innovative approaches, such as intermaxillary fixation (IMF) screws, hybrid arch bars, embrasure wires, and dental occlusion ties. The surge in new MMF technologies over the past decade prompted this analysis to compare these techniques. A PubMed search was conducted to identify all current FDA-approved modern MMF technologies from 2005 through 2023, evaluating their advantages and limitations. Studies with controlled scientific comparisons of techniques were limited, precluding a systematic review. Analysis showed no definitive data exist to endorse one technique as a universal option. As multiple MMF options offer appropriate stability, a surgeon may choose an approach based upon numerous factors: comminution/instability; need for physiotherapy, including guiding elastics; safety; time of application/removal; and patient comfort. This article guides the selection between techniques based on these factors and presents a decision algorithm to assist surgeons in selecting the ideal MMF technique for each patient.

Accidental Ingestion of Arch Bar During Intermaxillary Fixation for Maxillofacial Fracture: A Report of a Case

Accidental Ingestion of Arch Bar During Intermaxillary Fixation for Maxillofacial Fracture: A Report of a Case

A Comparative Study of Efficacy for Extra-Oral vs. Intra-Oral Mandibular Nerve Block in Arch Bar Fixation for Management of Mandibular Fractures.

The aim of the study was to evaluate and compare the efficacy of extra-oral mandibular nerve block (infra-zygomatic approach/lateral approach) vs. intra-oral (Gow-Gates) mandibular nerve block in arch bar fixation for management of mandibular fractures. A total of 200 patients reported with maxillofacial fractures. Out of them, 50 patients who required arch bar fixation for management of mandibular fractures were divided into two groups: Group I: Extra-oral and Group II: Intra-oral mandibular nerve blocks. The intra-operative pain, time of onset of anaesthesia, volume of drug administered, depth of needle insertion, repetition of injections and postoperative complications were analysed. In Group I (Extra-oral nerve block), the time of onset of anaesthesia, volume of anaesthesia administered, needle depth, number of repetition of injections and postoperative complications were more as compared to Group II. No significant difference was observed in intra-operative pain score between two groups. Intra-oral approach with Gow-Gates technique seemed to be efficient and easy to operate as compared to extra-oral approach, for arch bar fixation of mandibular fractures in an output door setting, as extra-oral approach is more technique-sensitive and may lead to certain complications which require operation theatre setting with medical attention.

An experimental study of a novel external fixator based on universal joints for the rapid initial stabilization of mandibular comminuted fractures

PurposeShaping and assembling contemporary external fixators rapidly for the severe mandibular fractures remains a challenge, especially in emergency circumstance. We designed a novel external fixator that incorporates universal joints to provide the stabilization for mandibular comminuted fractures. This study aims to confirm the efficacy of this novel external fixator through biomechanical tests in vitro and animal experiments. MethodsIn vitro biomechanical tests were conducted using 6 fresh canine with mandibular defect to simulate critical comminuted fractures. Three mandibles were stabilized by the novel external fixator and other mandibles were fixed by 2.5 mm reconstruction plates. All fixed mandibles were subjected to loads of 350 N on the anterior regions of teeth and 550 N on the first molar of the unaffected side. The stability was evaluated based on the maximum displacement and the slope of the load-displacement curve. In animal experiments, 9 beagles with comminuted mandibular fractures were divided into 3 groups, which were treated with the novel external fixation, reconstruction plate, and dental arch bar, respectively. The general observation, the changes in animals’ weight, and the surgical duration were recorded and compared among 3 groups. The CT scans were performed at various intervals of 0 day (immediately after the surgery), 3 days, 7 days, 14 days, 21 days, and 28 days to analyze the displacement of feature points on the canine mandible and situation of fracture healing at 28 days. The statistical significance was assessed by the two-way analysis of variance test followed by the Bonferroni test, enabling multiple comparisons for all tests using GraphPad Prism10.1.0 (GraphPad Inc, USA). ResultsThe outcomes of the biomechanical tests indicated that no statistically significant differences were found in terms of the maximum displacement (p = 0.496, 0.079) and the slope of load displacement curves (p = 0.374, 0.349) under 2 load modes between the external and internal fixation groups. The animal experiment data showed that there were minor displacements of feature points between the external and internal fixation groups without statistic difference, while the arch bar group demonstrated inferior stability. The CT analysis revealed that the best fracture healing happened in the internal fixation group, followed by the external fixation and arch baring at 28 days after fixation. The external fixation group had the shortest fixation duration (25.67 ± 3.79) min compared to internal fixation ((70.67 ± 4.51) min, p < 0.001) and arch baring ((42.00 ± 3.00) min, p = 0.046). ConclusionThe conclusion of this study highlighted the efficacy and reliability of this novel external fixator in managing mandibular fractures rapidly, offering a viable option for the initial stabilization of comminuted mandibular fractures in the setting of emergency rescue.

Airway management challenges in maxillofacial trauma with Erich arch bar placement and trans palatal wire.

Airway management challenges in maxillofacial trauma with Erich arch bar placement and trans palatal wire.

Management of Maxillofacial Injuries with Palatal Fracture

Maxillofacial injuries, especially palatal fractures, often result from high-energy trauma, posing a challenging treatment. Achieving good occlusion is crucial, particularly when palatal fractures are associated with Le Fort fractures. While tracheostomy has traditionally been the airway management option, submental intubation serves as an alternative. The objective of this report is to illustrate a case of palatal fractures associated with Le Fort fractures in a 12-year-old female following a motorbike accident. She was admitted to dr. Cipto Mangunkusumo Hospital with Le Fort I and II fractures and palatal fractures. The treatment plan included submental intubation, the application of wire and arch bars, and the use of plates and screws. The patient experienced a good recovery without complications. Compared to submental intubation, tracheostomy requires a significantly longer time and often necessitates scar revision. No significant difference was observed in post-operative occlusal stability between intra-arch wire and mini-plate. In conclusion, limited direct comparisons exist between submental intubation, tracheostomy, intra-arch wire, and miniplate for palatal stabilization. Submental intubation is a faster and less complication-prone alternative to tracheostomy in maxillofacial surgical procedures. However, evidence regarding the superiority of intra-arch wire or mini plate for palate stabilization remains inconclusive.

IMF screws with orthodontic E chains as a novel technique for intermaxillary fixation

AbstractIntroductionEither in conservative or in surgical management of maxillo‐mandibular fractures, intermaxillary fixation (IMF) provides stable occlusion, while offering reduction in the fractured segments. Various techniques have been used for achieving IMF, among which Erich arch bar is the most conventional and routinely used technique. However, it poses a risk of percutaneous injury to the surgical team with every wire used in the technique, causes trauma to the periodontium of the teeth secured by wires and it is not very comfortable for the patient. The few IMF techniques that are recommended without wire require special armamentarium that are not universally available.Materials and MethodsOur novel IMF technique employing multiple looping of orthodontic E chains around IMF screws can provide adequate reduction and stabilization of the fractured segments with good occlusion before plating of the maxillo‐mandibular fractures. It can also be utilized for extended periods for closed reduction or postoperatively for guiding the occlusion.ResultsAs seen in our clinical experience using this novel technique, there is no risk of percutaneous injury to the surgical team. It provides stable occlusion, optimal reduction in the fractured segments and is accepted well by patients as no wires are used.ConclusionThis novel technique can be used in all patients who require IMF and is particularly useful in patients with periodontally compromised teeth or in those who are partially edentulous where conventional arch bar fixation cannot be performed. This technique will considerably reduce the operative time and aid in better patient compliance.

A Novel Minimally Invasive and Cost-Effective Internal Fixation of the Le Fort I Fracture by Using Intermaxillary Fixation Screw and Wire: A Technical Note.

Le Fort I fractures represent a significant proportion of craniofacial trauma, often occurring alongside other injuries to the craniomaxillofacial region. Management options include open reduction and internal fixation (ORIF) or skeletal suspension, each with its limitations and considerations. This technical note presents a novel technique for managing isolated Le Fort I fractures using intermaxillary fixation (IMF) screws, offering a minimally invasive alternative to ORIF. The technique involves the strategic placement of IMF screws in the stable zygomatic bone, coupled with arch bar fixation and wire manipulation for maxillary fragment reduction. This approach is cost-effective, can be performed under local anesthesia, and provides stability without the need for prolonged maxillomandibular fixation (MMF). The simplicity and efficacy of this technique make it suitable for emergency settings and cases where traditional approaches may not be feasible. However, this technique is only feasible in isolated Le Fort I fractures and is contraindicated in comminuted Le Fort I fractures and in edentulous patients with upper jaw involvement.

Bilateral vertebral artery injury leads to brain death following traumatic brain injury: a case report

BackgroundVertebral artery injury is a rare condition in trauma settings. In the advanced stages, it causes death.CaseA 31-year-old Sundanese woman with cerebral edema, C2–C3 anterolisthesis, and Le Fort III fracture after a motorcycle accident was admitted to the emergency room. On the fifth day, she underwent arch bar maxillomandibular application and debridement in general anesthesia with a hyperextended neck position. Unfortunately, her rigid neck collar was removed in the high care unit before surgery. Her condition deteriorated 72 hours after surgery. Digital subtraction angiography revealed a grade 5 bilateral vertebral artery injury due to cervical spine displacement and a grade 4 left internal carotid artery injury with a carotid cavernous fistula (CCF). The patient was declared brain death as not improved cerebral perfusion after CCF coiling.ConclusionsBrain death due to cerebral hypoperfusion following cerebrovascular injury in this patient could be prevented by early endovascular intervention and cervical immobilisation.

Comparison between screw retained arch bars and conventional Erich’s arch bar in maxillofacial fractures

: Establishing a stable occlusion and Maxillomandibular fixation (MMF) is a cornerstone for rigid fixation. Conventional Erich’s arch bar poses a risk of wire stick injury, and extrusion of teeth, and is unsuitable for patients with periodontally compromised teeth or edentulous dentition. There is a dearth of literature comparing modified Screw retained arch bars to the Conventional Erich’s arch bar. Hence, a study was conducted to evaluate the same.: The study compared 30 patients requiring MMF. Group A patients received modified SRAB and group B patients received CEAB. The primary predictor variable was the use of conventional Erich arch bars versus modified screw-retained arch bars. The parameters considered were time taken to place the arch bar, perforation in the gloves, patient compliance, stability, oral hygiene, mouth opening, and post-op occlusion.: The mean time taken for placement of the modified SRAB was lower (27.87 mins) as compared to the CEAB (90.20 mins). The rate of glove perforation was higher in the CEAB group. All patients were compliant in the modified SRAB group as compared to the control group (30%). There was no significant difference in the mouth opening between the two groups.: Based on the study results, we can conclude that modified SRAB is a superior alternative compared to CEAB in maxillomandibular fractures. The usage of modified SRAB does not affect the functional outcome of fracture management.

The Evaluation of Objective and Subjective Fate of Teeth in the Mandible Fracture Line and the Management-A Center's Experience.

The decision to retain or extract teeth in the line of mandibular fractures has been a subject of debate in much of the scientific literature, and there is a need for further evidence to clear this issue. Thus, the aim of this study was to investigate both the positive and negative effects of teeth in the line of mandibular fractures provide more evidence in this field, as well as take into consideration patients' quality of life after the surgery. Patients after trauma with teeth in the line of mandibular fractures were included in this study. Open reduction and rigid internal fixation, elastic intermaxillary reduction were expected to achieve a satisfactory occlusion and/or anatomical reduction in the fragments as assessed by orthopantomogram, computed tomography scans, and clinical examination. The remaining cases had maxillomandibular fixation (MMF) with an arch bar and bridle wire. All the patients included in this study will take the Visual Analog Scale score evaluation before and after surgery subjectively to further verify the impact on their life qualify, as well as the further treatment needed. A total of 78 patients with teeth in the line of mandibular fractures were included in this study. Open reduction and rigid internal fixation was used in 37 patients, whereas another 35 patients accepted elastic intermaxillary reduction. Six cases underwent MMF. The number of involved teeth was 83. Three of the 83 teeth involved in the fracture lines healed with complications. In the cases where the teeth had been removed before fracture treatment, or in cases of delayed extractions, no complications were noted. The majority of the patients felt good about the whole treatment, however, 4 in the MMF group complained about worry about their oral health due to MMF leading to mouth open limitation. The factors that should be considered for removal include the condition of the teeth and alveolar bone, the timing and the type of treatment, as well as the patients' desire, if possible. This is an individual-based decision that needs to consider more objective and subjective potential risks to avoid complications.

The use of orthodontics in the management of a bilateral condylar fracture in a child

Mandibular fractures in children are different to those in adults. Greenstick fractures are more commonplace, and displacement less frequently encountered. They are mostly treated conservatively; however, if the occlusion is altered, then reduction will be required. Closed reduction is normally favoured in children because open surgical reduction and internal fixation may impair future growth. Closed reduction is often carried out with arch bars or splints. These may be traumatic and painful for the child. This case report describes the case of a 12-year-old boy who presented with bilateral condylar fractures with displacement and deranged occlusion. Minimal fixed appliance treatment was used to reduce the fractures and restore him to his pre-injury occlusion. CPD/Clinical Relevance: Minimal orthodontic treatment can be used to reduce a bilateral condylar fracture with displacement in paediatric mandibular fractures.

Comparison of hybrid arch bar versus conventional arch bar for temporary maxillomandibular fixation during treatment of jaw fractures: a prospective comparative study.

This study aimed to compare the effectiveness of a hybrid arch bar (hAB) with the conventional Erich arch bar (EAB) for the management of jaw fractures, focusing on their use for temporary fixation in patients undergoing open reduction and internal fixation (ORIF). Patients presenting with maxillary and mandibular fractures at our institution were included in this prospective, comparative study. Placement time and ease of occlusal reproducibility were recorded intraoperatively for Group A (hAB patients) and Group B (EAB patients). The primary outcome was comparison of the postoperative stability of the two arch bars. Postoperative measurements also included mucosal overgrowth, screw loosening or wire retightening, and replacement rates. The data were tabulated and computed with a P<0.05 considered statistically significant. The study included 41 patients. A statistically significant difference was observed in postoperative stability scores (3) between Group A and Group B (85.0% vs 9.5%, P=0.001). The mean placement time in Group A (23.3 minutes) significantly differed from that in Group B (86.4 minutes) (P<0.001). The ease of intraoperative occlusion was not different between the two groups (P=0.413). Mucosal overgrowth was observed in 75.0% of patients (15 of 20) in Group A. The hAB was superior to EAB in clinical efficiency, maxillomandibular fixation time reduction, stability, versatility, and safety. Despite temporary mucosal overgrowth, the benefits of hAB outweigh the disadvantages. The choice between hAB and EAB should be based on specific clinical requirements.

New Wind and Pressure-resistant Structural Design and Static Simulation Analysis of Continuous Greenhouse

To improve the wind and snow resistance of the continuous round-arch greenhouse skeleton structures, a new wind and pressure-resistant continuous greenhouse with arch spars and diagonal ties is designed in this study. By increasing the number of secondary arches, arch spars, and diagonal ties, and optimizing the traditional spars, this skeleton structure not only improves the snow pressure resistance of arch bars but also enhances the resistance to wind loads. Taking wind load and snow load in the Hangzhou area of Zhejiang province as an example, ANSYS workbench software was used to analyze and calculate the stress and displacement of this shed, and it was found that the maximum stress value could reach 88.641 MPa and the maximum bit amount was 10.316 mm. Compared with the traditional plastic continuous shed, the optimized structure of wind and pressure-resistant continuous shed can effectively reduce the arch displacement and enhance the stability of the structure.

Comparison of Efficacy Between New Method and Conventional Arch Bar Fixation Technique in Facial Bone Fracture Management – A Randomised Clinical Trail

Introduction - In this study efficacy of new method for arch bar fixation was compared with conventional technique in facial bone fracture management Material and Methods - 20 Patients with facial bone fracture reported to the Department of Oral and maxillofacial Surgery requiring open reduction were included in the study. The clinical parameters that were evaluated are Oral hygiene and Gingival index. Results - The mean OHI-S score in new technique and conventional technique in 1st week was 1.36 ± 1.19 and 0.81±0.53 respectively. In 2nd week the mean OHI-S score in new technique was 1.22 ±0.77 and in conventional technique the mean OHI-S score was 1.39 ± 1.51.In the 3rd week the mean OHI-S scores of new technique and conventional technique were 1.8 ±0.55 and 1.6 ±1.73 respectively. The mean GI score in new technique and conventional technique in 1st week was 0.69 ± 0.5 and 0.38 ± 0.3 respectively. In 2nd week the mean GI score in new technique was 0.63 ±0.4 and in conventional technique the mean GI score was 0.36 ± 0.3. In the 3rd week the mean GI scores of new technique and conventional technique were 0.65 ±0.3 and 0.35 ± 0.3 respectively. Conclusion - In a whole we can conclude from this clinical study that both the techniques were equally effective in terms of Oral hygiene, gingival health and stability. Key Words - Erich arch bar; Intermaxillary fixation; Intermaxillary fixation screws; maxillofacial trauma; oral hygiene status.

Modified Eyelet Wiring: A Technical Note.

The objective of establishing intra-operative occlusion by temporary inter-maxillary fixation remains constant even with evolving principles for the treatment of facial fractures. In the novel technique, a pre-stretched 24- gauge round stainless-steel wire of six inches length is used. The novel technique is a modification of the conventional eyelet wiring, which can achieve both horizontal stabilization and maxillo-mandibular fixation. We have devised a technique that overcomes the relative bulky and rigid arch bars which may not be welltolerated by the patients and the damage to the radicular structures during the placement of IMF screws.

Management of Lingual Cortex Fracture of Mandible Using Lingual Arch Bar: A Finite Element Analysis of Reduction with a Pilot Clinical Trial.

Fractures of lingual cortex are frequently left untreated leading to poor resolution of patient's symptoms and function. Positioning an implant on same side of fracture would provide better reduction. The study aims at improving stability offered by Erich arch bar placed on lingual surface, by Finite element analysis (FEA) along with a pilot clinical trial. Two FEA models were generated from CT scan of an individual having lingual cortex fracture: control model with labial arch bar and study model with lingual arch bar. Parameters assessed: Stress distribution (Mpa) along lines of osteosynthesis; Separation of fracture fragments (mm) across fracture line. Associated, was a clinical trial of 5 patients, managed by placing lingual arch bar. Feasibility of arch bar, post-operative pain, radiographic inter-fragmentary gap and complications were assessed clinically. Lingual positioning of arch bar demonstrated less displacement (mm) of fracture fragments compared to labial placement (0.123 vs. 0.677) upon application of masticatory load. Insignificant lingual splay and lesser degree of stress distribution (Mpa) was observed (83.1 vs. 99.3) favoring placement of arch bar on lingual side. Clinical trial correlated with outcomes of FEA, resulting in improvement of patient's symptoms. FEA and supporting clinical trial provided an effective method of reduction for lingual cortical fracture.

A truss-arch model-based method for calculating shear walls with small shear span ratio

In this paper, based on the equivalent diagonal web truss-arch (EDWT) model and considering different failure modes and deformation coordination conditions, a method for calculating the shear capacity of shear walls with small shear-to-span ratio is proposed. The method considers the effects of both horizontal and vertical reinforcements in the web on the shear capacity of the member through the stress equivalence principle in the truss action, and an empirical formula to calculate the height of the compression zone for determining the section height of the concrete diagonal compression truss are also proposed. The test data of 359 small shear-span ratio shear walls were collected, and their shear capacity was calculated using the method proposed in this paper, and compared with the Chinese, American, European and Japanese codes. The results show that: except for the Japanese AIJ code, the calculation of shear capacity of small shear span ratio shear wall is conservative, while the AIJ code overestimates the height of the arch bar, which makes its calculation results unconservative; while the proposed formula can calculate the shear bearing capacity of small shear span ratio shear wall more accurately.

Evaluation of osteosynthesis of miniplate versus lag screw in management of mandibular angle fracture - A comparative study

The aim of the study was to compare lag screw and standard (Champy’s) miniplate fixation in the management of mandibular angle fractures and to analyze advantages and disadvantages of one over the other. A total of 30 patients involving mandibular angle fracture reporting to the Department of Oral, Maxillofacial and Reconstructive Surgery, Bapuji Dental College and Hospital, Davangere, were included in the study. Patients were divided into two groups randomly. The procedure was carried out under general anesthesia. Following strict aseptic precautions, an appropriate intraoral/extra-oral incision was selected; fracture site identified, reduced, and after obtaining satisfactory occlusion, temporary maxillo-mandibular fixation was placed using either Erich’s arch bar or Ivy loop eyelet wiring. Fixation was done using either standard miniplate (Group 1) or lag screw (Group 2). The patients were followed up for a period of 2 months at the interval of 1 week, 2 weeks, 4 weeks, and 8 weeks by a blinded experienced oral surgeon for infection, segmental mobility, postoperative occlusion and radiological evaluation of reduction and fixation. Duration of fixation was found to be less in lag screw group than in miniplate group. Radiological evaluation of reduction and fixation was significant in both the groups. No significant difference was found between both the groups in clinical parameters such as infection, segmental mobility and postoperative occlusion. The clinical outcomes of both the lag screw system and standard miniplate systems in the present study were similar. However, the following advantages with the use of lag screw can be highlighted: Relatively lesser fixation time, Superior fracture fragment stability, fewer complications, Stable occlusion &amp; less hardware, less cost required.

THREE YEARS FOLLOW UP REPLANTATION IN HEAVY SMOKER PATIENT: CASE REPORT

Tooth avulsion is different from all other dental injuries due to the extracorporeal situation with varying duration and degree of contamination of the teeth and the patient's systemic conditions. In a heavy-smoker patient, wound healing could be interrupted. Extra-alveolar handling, good replantation, and educating the patient could be the key to successful treatment of tooth avulsion, especially in a heavy smoker. The aim of this study is to discuss an avulsed tooth case that has been successfully treated by replantation in a heavy smoker. A 39-year-old female patient was refered to Siloam Hospital due to a dental trauma injury. The patient was in good general health, but she was a heavy smoker. Intraoral examination revealed that the maxillary left permanent central incisor was avulsed after the patient fell off in her bathroom. Replantation is a treatment of choice in this case. The avulsed tooth was stored in a saline solution. On one visit, root canal treatment was done on the avulsed tooth extra orally soon after the patient was refered to the AE department at Siloam Hospital. The avulsed tooth was replanted and fixed using an Erich arch bar to the previous position by finger pressure. Fix the Erich bar as far as possible to the distal and mesial of the avulsed tooth using circumferential wire in every single tooth. We decided to put the Erich bar from 15 to 25. The following oral hygiene cleaning, dietary instructions, and education to reduce or stop smoking during the healing process were given. Extra-alveolar handling, good replantation, good fixation, and adequate oral hygiene education are the keys to treating a tooth avulsion, even in a heavy smoker.