Period Of Intermaxillary Fixation Research Articles

Open versus closed treatment for extracapsular fracture of the mandibular condyle.

Selection of treatment methods for mandibular condylar fractures remains controversial. In this study, we investigated treatment methods for condylar fractures to determine the indications for open or closed reduction. Patients and. Patients >12 years of age treated for mandibular condylar fractures with a follow-up period of ≥3 months were included in this study. The medical records of enrolled patients were reviewed for sex, age, fracture site, treatment method (open or closed reconstruction), postoperative intermaxillary fixation period, operation time, and complications. Radiological analysis of fracture fragment displacement and changes in ramal height difference was performed using computed tomography and panoramic radiography. A total of 198 patients was investigated, 48.0% (n=95) of whom underwent closed reduction and 52.0% (n=103) underwent open reduction. There was no significant correlation between reduction method and patient sex, age, or follow-up period. No statistically significant difference between the incidence of complications and treatment method was observed. None of the patients underwent open reduction of condylar head fracture. Binary logistic regression analysis showed that open reduction was significantly more frequent in patients with subcondylar fracture compared to in those with a fracture in the condylar head area. There was no statistically significant correlation between the groups and fracture fragment displacement. However, there was a significant difference between the treatment groups in amount of change in ramal height difference between the fractured and the nonfractured sides during treatment. No significant clinical differences were found between the open and closed reduction methods in patients with mandibular condylar fractures. According to fracture site, closed reduction was preferred for condyle head fractures. There was no significant relationship between fracture fragment displacement and treatment method.

Effect of intermaxillary fixation on paraclinical indexes

Among trauma cases, maxillofacial injuries have a very high incidence. Data suggests that the leading causes of maxillofacial fractures in developed countries are falling and insult, on the other hand road traffic accidents is the main reason in case of developing nations. For mandibular or midface fractures, various treatment modalities can be employed. One of them is closed reduction via intermaxillary fixation (IMF).Materials and Methods: This study was conducted in the department of Oral and Maxillofacial Surgery, from 1st July 2020 to 30th September 2021. This study comprised patients of all ages and both. All patients were aged 15-50 years and had a BMI of 18-30 kg/m2. We included only the patients whom undergone 4 weeks of IMF and excluded patients who had any systemic problems such as diabetes, kidney or heart diseases. Results: A total of 80 patients were included in this study (56 male and 24 female) with an age average of 28 years. In this study, the mean of TC of patients at the start point of the study was 157.6mg/dl which ended up 149. mg/dl after the 4 weeks of IMF period .The HDL of the serum of the patients before the treatment had a mean of 54.1 mg/dl. After the IMF period, the mean decreased about 1.1 mg/dl and reached 53.0. The average of LDL was 86.4 mg/dl, which also decreased during the IMF period about 3.3 mg/dl and reached 83.1 mg/dl.Conclusion: We could show according to patients lipid indexes treatment with IMF can result in decrease in total cholesterol levels as the diet is restricted.

Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience.

BackgroundIntermaxillary fixation (IMF) is a technique that allows for the reduction and stabilization of mandibular fractures. Several methods of IMF, such as self-tapping screws or arch bars, have been developed. This study aimed to validate the usefulness of IMF with a self-tapping screw compared to IMF with arch bars with focus on the patients’ perspective.MethodsWe retrospectively reviewed the medical records of all patients who were treated for mandibular fractures at our hospital between August 2014 and February 2021. A total of 57 patients were enrolled in this study. Thirteen patients were excluded from the analysis: three patients were lost to follow-up, and 10 patients did not undergo IMF. Finally, 44 patients were analyzed, of which 31 belonged to the arch bar group, and 13 belonged to the screw group. Patient discomfort and pain during IMF application and removal were analyzed using a patient self-assessment questionnaire. The surgeon also assessed oral hygiene, IMF stability, and occlusion.ResultsWe applied IMF to 34 men (77%) and 10 women (23%). The mean age of the patients was 37.3 years. The most common fracture site was the angle (30%), followed by the parasymphysis (25%), the body (23%), the condyle (11%), and the ramus (11%). Patient discomfort and oral hygiene were statistically favorable in the screw group. The IMF application time was statistically shorter in the screw group (p<0.001). IMF stability was not statistically different between the two groups. The pain score during IMF removal was lower in the screw group (p<0.001).ConclusionCompared to arch bars, IMF screws provide more comfort during the IMF period, help maintain favorable oral hygiene, and have a shorter application time. From the patient’s perspective, IMF screws are an excellent alternative to conventional arch bars when applicable.

Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience

Verrucous carcinoma (VC) is a rare subtype of squamous cell carcinoma that commonly occurs in the oral cavity. However, VC of the facial skin is relatively rare. We report a case of a 91-year-old woman with VC of the facial skin in the left zygoma area. She was diagnosed with actinic keratosis (4 × 3 cm) of the same site approximately 12 years previously, but declined further treatment. The mass was excised with a minimum of 0.4 cm from gross margins with the result of free from tumor of all margins by frozen section, allowing for primary closure after skin undermining. Basal resection was performed in the preplatysmal plane. The diagnosis of VC was confirmed by histopathological examination. Postoperatively, the wound healed without incident and with no signs of facial nerve injury. To our knowledge, this is the first reported case of VC of facial skin arising from actinic keratosis.

Intermaxillary fixation with bra hooks

Conservative management of mandibular condylar fractures is frequently employed, particularly when there is minimal displacement at the fracture site. Options include functional therapy without a period of intermaxillary fixation (IMF) versus a short period (approximately two weeks) of IMF followed by functional therapy, soft diet, and pain medication as required.1

Major clinical considerations and treatment of mandible fracture: a concise systematic review

Introduction: In the scenario of mandible fractures, traumas are the main reasons for these events. In this context, the rates of mandible fracture complications vary from 7 to 29% and were correlated with the severity of the fracture. Motor vehicle assaults and collisions significantly outperformed all other causes of mandibular injury. Most consultations for mandible fractures begin with a diagnosis of computed tomography imaging (CT). CT scans were 100 percent sensitive for fractures of the mandible compared to 86 percent for panoramic radiographs. Despite this, radiographic images are not a substitute for a complete history and clinical examination. Objective: To carry out a narrative and systematic review of the literature, to explore the main literary findings and clinical results on fractures of the mandibles. Methods: It followed a systematic literature review model on the main clinical findings of mandible fractures, according to the rules of PRISMA. The research was carried out from January 2021 to May 2021 and developed based on Google Scholar, Scopus, PubMed, Scielo, and Cochrane Library. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 170 studies were analyzed, with only 34 studies of medium and high quality being selected, according to GRADE standards, and with risks of bias that do not compromise scientific development. Most mandible fractures require stabilization for proper treatment and to restore pre-injury occlusion. Although mandible fractures with good dentition on both sides of the fracture line can be treated in some cases by a period of intermaxillary fixation, most surgeons and patients prefer open reduction and internal fixation, as the process is faster. The use of two mini-plates results in better results with minimal complications. The treatment of mandibular fractures should aim to restore functional occlusion and mandibular continuity with the lowest possible risk. Open treatment of unilateral mandibular condyle fractures results in better functional results, especially in terms of mandible mobility. Finally, the application of low-intensity pulsed ultrasound can reduce postoperative pain and facilitated fracture healing in patients with impaired healing potential.

Change of body composition, physical strength, and nutritional status of patients with mandibular fractures

The aim was to determine changes in various parameters indicating physical conditions and nutritional status of patients during surgical and conservative treatment of mandibular fractures.A round by a nutrition support team was done once postoperatively for the surgical treatment group. For the conservative treatment group, three rounds were performed during the period of intermaxillary fixation. Data obtained from the rounds were compared between the groups.There were 29 patients surgically and 30 patients conservatively treated. A significant weight loss was observed in both groups postoperatively. The mean weight loss of the surgical treatment group measured at the postoperative round was 1.73 kg (SD ± 1.78) (P < 0.001) and that of the conservative treatment group at the third round was 2.74 kg (SD ± 2.35) (P < 0.001). During the entire treatment period, weight loss, body fat percentage, skeletal muscle percentage, grip strength and parameters indicating body composition and nutritional status of the conservative treatment group did not substantially differ from those of the surgical group.The influence of the conservative procedure on the nutritional condition of the patients seems to be limited and reversible at the end of the treatment. The weight loss observed here suggests that systematic nutrition support is necessary during both surgical and conservative treatment.

Comminuted Mandibular Fractures in a Pediatric Patient: A Case Report with Review

Background and Introduction:Maxillofacial fractures are less common in children. Mandibular fractures are less in children because of the protective anatomy in them. Management of the pediatric fracture depends on the type and severity of the fracture displacement. It can vary from conservative management with acrylic splint and arch bar fixation to surgical exposure of the fracture site with internal fixation. Special consideration is needed in children for the interferences of growth and developing tooth buds while going for the surgical management. The hardware for internal fixation can be made up of either titanium or bioresorbable material.Case Presentation:Here is the presentation of a case of a 7-year-old male patient who had a history of trauma because of falling from a tractor while playing, 2 days back from reporting. He had multiple mandibular fractures with extensive soft tissue laceration. Following the emergency tracheostomy, he was managed with open reduction and internal fixation of the compound mandibular fracture.Conclusion:Displaced mandibular fractures require open reduction and internal fixation of the fractured fragments with either titanium or biodegradable hardware. Open reduction also shortens the period of intermaxillary fixation and hence reduces the possibility of the development of temporomandibular joint (TMJ) ankylosis.

The Inverted Coronoid-Ramus Graft for Condylar Reconstruction

The purpose of this article is to describe a creative, versatile technique for condylar reconstruction using autogenous mandibular bone. The technique has been used for reconstruction of small condyle and/or ramus defects (approximately 35 to 40mm in length) typically associated with condylar hyperplasia, condylar tumors, idiopathic condylar resorption, and failed reconstruction attempts.The technique involves excision of the ipsilateral coronoid process-mandibular ramus, inverting it and rotating the segment 180° along its horizontal axis to replace the excised condyle. The resultant graft simulates the morphology of the posterior aspects of the ramus and condyle and has been shown to resist resorption typical of endochondral bone grafts harvested from the rib or iliac crest. Grafting is carried out via vestibular and preauricular or endaural incisions. Four cases followed over a period of 3 to 40months (average, 21months) are presented. No adverse functional results, including ankylosis, removal of hardware or adverse remodeling, have occurred. A period of intermaxillary fixation is used because it is considered beneficial for intra-articular scarring of the subglenoid fossa pad (disc or retrodiscal tissue and fibrocartilage) and initial healing. Physical therapy has not been prescribed. The inverted coronoid graft is a versatile technique when virtual surgical planning is used to assess feasibility, as well as defect and graft dimensions; fabricate custom bone plate and drilling guides; and determine screw osteosynthesis sites. In general terms, a post-reconstruction opening of 35mm allows for adequate function and guards from contralateral symptomatic hypermobility given disparate right- and left-sided joint mechanics. In the cases described, a mean of 40.5mm was achieved; however, in 2 of these cases, this was measured with undesirable asymptomatic (preoperative) deviation to the ipsilateral side by greater than 4mm and by 6mm. The inverted coronoid graft technique reduces operative time, can be executed with few external scars, and reduces the number of operative fields.

Lag Screw Technique for Treating a Mandibular Angle Fracture: Case Report

The treatment of mandibular angle fractures involves several postsurgical complications and is in greater demand when compared to therapeutic approaches for other types of mandibular fractures. Such postsurgical complications as bleeding, swelling, infection, dehiscence, pseudoarthrosis and paresthesia might affect individuals in both sexes and at all age groups. The presence of a mandibular third molar, a cross-sectional area thinner than the tooth-bearing region, and biomechanical forces might hamper the surgery, making it longer and more complex. Internal fixation is aimed at undisturbed healing under condition of functional and without any period of intermaxillary fixation. Adequate fixation depends on different fracture types, patients' general health and compliance, and the timing of the operation. This case report involves a mandibular angle fracture successfully treated with the lag screw technique, a simple approach to treat one of the most common fractures involving the mandible, quickly restoring the patient ́s oral functions.

Evaluation of changes in anthropometric indexes due to intermaxillary fixation following facial fractures.

Background. One of the treatment modalities for facial fractures is closed reduction technique, but treatment with intermaxillary fixation (IMF) interferes with normal nutrition, and malnutrition can affect the patient’s recovery. Anthropometric measurements such as skinfold thickness and body mass index (BMI) are universal indexes for diagnosing malnutrition. Therefore, in this study we explain how treatment with IMF changes the anthropometric indexes.Methods. In this study 60 patients were treated with 4 weeks of IMF. Skinfold thickness and BMI of these patients were measured and compared before and after the treatment.Results. Patients’ weight, BMI and skinfold thickness decreased during the IMF period, and this decrease was statistically significant (P < 0.01).Conclusion. Although no severe and acute malnutrition was seen among our patients, IMF led to mild to moderate malnutrition in some cases, making it necessary to use nutritional supplements.

Use of bioresorbable plating systems in paediatric mandible fractures

AimThe aim of this study is to retrospectively evaluate the use of bioresorbable plating systems in the rigid fixation of paediatric mandible fractures. Patients and methodsOur series consists of fifteen paediatric patients (11 male, 4 female, average age 8.13 years) with mandible fractures of varying severity treated with bioresorbable plates over a 54-month period at our institution. Fractures of the ramus, body, parasymphysis, and symphysis were treated by one surgeon with open reduction and internal fixation with 1.5 mm and 2 mm resorbable plates and monocortical screws, using 3 different plating systems, each with differing polymer concentrations of polyglycolic and poly-l-lactic acid. The patients were followed with respect to the following clinical categories: fracture location, postoperative occlusion, maximum interincisal opening (MIO), segmental mobility at the fracture site, and any abnormal swelling at the operative site. ResultsOur data shows a stable occlusion and maximum interincisal opening of thirty millimetres or greater was achieved in 14 of 15 patients seen in follow up, with 8 patients having an MIO of 40 mm or greater. No segmental mobility noted at any of the fracture sites. Thirteen patients had no postoperative sequelae or implant related complications. Two patients developed a seroma-like collection at the operative site. Postoperative films starting at 1 year showed significant bony osseous fill where the previous screw sites were located. ConclusionsIn our case series we found that the use of resorbable polyglycolic and poly-l-lactic acid plating systems when combined with a brief postoperative period of intermaxillary fixation is an effective method of internal fixation for mandibular fractures in the paediatric population.

Maxillomandibular Tandem Osteotomy With Distraction Osteogenesis for Hemifacial Microsomia

Currently, simultaneous maxillomandibular distraction osteogenesis is a standard procedure for the correction of hemifacial microsomia. Many variations of the procedure have been reported. However, a common problem has been the extended duration of the procedure. In particular, the lengthy intermaxillary fixation period includes a prolonged distraction series that requires the restriction of oral food intake and creates significant stress for the patient, which has a profound effect on patient satisfaction. To avoid this stress, we have developed tandem osteotomy with distraction osteogenesis, termed the TODO procedure. The TODO procedure not only shortens the intermaxillary fixation period and the duration of therapy but also creates the ideal skeletal proportions, with horizontalization of the occlusal plane. The TODO procedure has the added benefit of producing a marked aesthetic improvement. The patient was extremely satisfied by the result and endured minimal stress.

Is Healing Outcome of 2 Weeks Intermaxillary Fixation Different From That of 4 to 6 Weeks Intermaxillary Fixation in the Treatment of Mandibular Fractures?

This study was undertaken to compare the healing outcome of a short period (2 weeks) of intermaxillary fixation (IMF) with conventional (4-6 weeks) IMF in the management of fractures of the mandibular tooth-bearing area. This was a randomized controlled study conducted at the Lagos University Teaching Hospital, Lagos, Nigeria, between November 2007 and January 2009. Subjects with minimally displaced mandibular fractures in the tooth-bearing area were randomly allocated into 2 treatment groups: IMF for 2 weeks (study group) or IMF for 4 to 6 weeks (control group). For the purpose of study analysis, the primary predictor variable was the treatment (IMF for 2 weeks vs IMF for 4-6 weeks). Other predictor variables were the age and gender of subjects. The primary healing outcome was considered either satisfactory or unsatisfactory. The following outcome variables that described the healing process were also compared in the 2 groups: healing time, postoperative infection, paresthesia, and maximal interincisal opening. Loss of body weight and oral hygiene status at the end of treatment were compared in the 2 groups. A value of P < .05 was considered significant. Satisfactory healing was observed in all cases in both groups. However, satisfactory healing was observed earlier (5.4 ± 0.9 weeks) in the control group than in patients with the short IMF period (7.2 ± 0.9 weeks) (P < .001). Malocclusion that was amenable to selective grinding was the only complication seen in both groups (n = 2 in study group and n = 1 in control group) (P = .492). Subjects in the control group lost more weight after treatment than those in the study group (P < .001). The recovery of interincisal mouth opening was also better in the study group than in the control group (P < .001). The study group had better oral hygiene than the control group at the end of treatment. The healing outcome was comparable in both groups. However, the healing time was significantly longer in the group with the short IMF period. The recovery of maximal mouth opening, oral hygiene status, and loss of weight body in the study group were significantly better than those in the control group. This study suggests that a short period (2 weeks) of IMF in the management of minimally displaced mandibular fractures of the tooth-bearing area in young adults is a suitable alternative to the conventional method in terms of the healing outcome.

Optimizing Pediatric Interdental Fixation by Use of a Paramedian Palatal Fixation Site

Condylar fractures are the most common injury seen in pediatric mandibular trauma. These injuries often cannot be adequately stabilized by conservative techniques such as splinting. The pediatric condyle fracture often requires a period of intermaxillary fixation. Because of the characteristics of the developing dentition, circumdental wiring is often not possible. Surgeons commonly achieve interdental stabilization by the connection of a circum-mandibular wire and a second wire placed through a drill hole in the piriform aperture. This method can be problematic in the young patient whose palatal suture is still patent. In this brief technical note, the use of a paramedian drill hole through the palate posterior to the maxillary incisors is described. It is believed that this method is superior to other techniques because it avoids injury to the deciduous tooth buds and allows for the maxillary wire to be seated in more structurally sound tissues.

Unusual longitudinal fracture of coronoid process of mandible: A case report

Though fractures of the mandible are relatively common injuries, the coronoid process fractures have extremely rare occurance. Reports of longitudinal fracture of the coronoid process of the mandible are very rare. On literature search, only two previously reported cases of such type of fracture were found. We report a very rarely occurring longitudinal fracture of the coronoid process. The clinical features, diagnosis, mechanism of fracture and treatment modalities are discussed along with comprehensive review of literature. Though the incidence of longitudinal fracture of the coronoid process of mandible is very rare, its diagnosis is of atmost importance. When such fracture occurs in association with fracture of zygomatic bone or condylar process of the mandible we strongly advocate vigerous mobilization of the mandible after a short period of intermaxillary fixation to avoid post operative complications like diminished mouth opening, trismus and ankylosis.

THE HEALING OF MANDIBULAR FRACTURE WITHOUT INTERMAXILLARY FIXATION IN A LONG-TERM DISABLED BED PATIENT: REPORT OF A CASE

Treatment of the mandibular fracture consists of reduction and fixation. Primary wire & Arch bar are perhaps the ideal method for intermaxillary fixation. But, daily feeding, swallowing, speech, and in some instances, respiration is difficult to maintain during the period of intermaxillary fixation, owing to muscle weakness, emotional disorder and poor oral hygiene in a position of the long-term bed disabled patient with multiple injuries. Therefore, Intermaxillary fixation is not applied in the disabled bed patient, the alternative methods must be obtained. In the case of the mandibular fracture, because of the absence of weight bearing, osseous union may eventually occur even without immobilization if the patient is maintained without wound infection on a controlled soft diet. For the purpose of the prevention of the wound infection, the establishment of an drainage on the oral lacerated wound is necessary for the removal of the hematoma & seroma in the fracture site. This is the report of a case that was managed conservatively without the intermaxillary fixation in the long-term disabled bed patient with a mandibular compound fracture.

A questionnaire survey on postoperative intermaxillary fixation in mandibular trauma: Is its use based on evidence?

Context:This questionnaire survey was conducted to ascertain if the practice of the routine use of postoperative intermaxillary fixation (IMF) in mandibular trauma (of the dentate segments only) was based on evidence available in the literature.Settings and Design:This study was designed as a questionnaire survey that would be conducted among surgeons operating on mandibular fractures in the state of Gujarat.Materials and Methods:A typed questionnaire was sent to oral maxillofacial surgeons and plastic surgeons of Gujarat state for their feedback by post. Approval of the ethical committee of the university was obtained. All the feedback forms received back were included for this survey which included 25 oral and maxillofacial surgeons and 25 plastic surgeons.Results:Although majority of the surgeons use open reduction and internal fixation (ORIF), 25% of the surgeons still prefer using only IMF as the sole modality of treatment for the said group of mandibular fractures. According to our survey, the majority of surgeons use IMF routinely in the postoperative setting even after using ORIF. Occlusion seems to be the critical factor among 72% of surgeons in deciding on the use of IMF as an adjunct after ORIF. Seventy-eight percent of surgeons vary their period of IMF based on the site of fracture.Conclusion:The routine use of postoperative IMF in cases of mandibular fractures seems to find favor among surgeons despite lack of sound scientific evidence supporting its use. There is also no evidence to suggest that if IMF is not used, it would have deleterious effects on occlusion or otherwise.

A New Condyle Repositionable Plate for Sagittal Split Ramus Osteotomy

In sagittal split ramus osteotomy (SSRO) surgery, variable methods are used to maintain the proximal segment in the anatomic position during fixation to minimize early built-in relapse. However, there is still a chance of condyle malposition.In this study, a new titanium plate, which has a sliding oval hole in its distal part, was used to enable postoperative mobility of the proximal segment. This plate makes it possible to reposition the condyle during the postoperative intermaxillary fixation period.These plates were used successfully in 23 patients who received SSRO setback surgery. All of the patients were followed up without any complications, including early relapse or temporomandibular joint problems.The authors used a new plate that enables sliding of the proximal segment after SSRO, which can minimize early relapse without any postoperative complications.

Effect of fracture healing on the fixation of a parasymphyseal mandibular fracture: a study using the finite element method

Trauma surgeries involving rigid internal fixation of mandibular fractures are often supplemented with a short postoperative period of Intermaxillary Fixation (IMF) or soft diet to delay patient functioning. A finite element model of the human mandible with a parasymphyseal fracture was created and anatomically loaded to determine the effect of fracture healing on measures associated with complications. Stress and strain measures were recorded while the stiffness of the fracture was increased to mimic fracture healing. According to the results of the model, delaying normal functioning for two weeks decreases stress and strain measures up to 50%.