Simplifying intermaxillary fixation in orthognathic surgery using customized surgical archwire with clear aligners: a technical note and exemplifying case.

Le Fort I fractures with concurrent palatal fractures are rare, necessitating precise stabilization of facial buttresses to restore function and aesthetics. Conventional management includes maxillary open reduction and internal fixation combined with intermaxillary fixation. However, palatal fractures pose additional challenges, particularly during masseter muscle contraction, often resulting in dental arch widening. Lingual splints are commonly utilized to stabilize the dental structures and prevent dental arch widening, but traditional acrylic splint fabrication is time-consuming. In this study, we report on a 36-year-old female patient who suffered from facial contusions following a traumatic accident, which led to the diagnosis of Le Fort I fracture combined with palatal fracture. To address these challenges, we introduced thermoplastic polycaprolactone (PCL) as an innovative and instant material for lingual splint fabrication. The use of PCL significantly reduced the intraoperative preparation time by eliminating the need for preoperative dental impressions and reducing fabrication time from hours to just a few minutes. Compared to traditional acrylic splints, the PCL-based splint proved to be biocompatible, efficient, and cost-effective, thereby simplifying the management of maxillary fractures and promoting optimal healing outcomes.

Background: Mandibular condylar fractures constitute nearly one-third of all mandibular fractures and, if inadequately treated, may result in significant functional and anatomical sequelae. While closed reduction has traditionally been preferred, open reduction and internal fixation (ORIF) through the retromandibular transparotid approach (RMA) provides direct visualization, stable fixation, and anatomical accuracy. Aims and Objectives: This study aimed to evaluate the effectiveness, safety, and post-operative outcomes of the RMA in the management of condylar and subcondylar fractures. Materials and Methods: A prospective clinical observational study was conducted in the Department of Oral and Maxillofacial Surgery, Bharatpur Hospital. Twelve patients with condylar neck or subcondylar fractures underwent ORIF through the RMA. Clinical and radiographic data were analyzed for operative access, duration, mouth opening, occlusion, facial nerve function, scarring, and complications. Results: The patients (10 males and two females; mean age was 36.3 years, range 21–56 years) showed excellent functional recovery. The mean post-operative interincisal opening improved to 28.6±4.8 mm (P=0.001). All patients achieved satisfactory occlusion intraoperatively; one patient developed a minor occlusal discrepancy, which was corrected with selective intermaxillary fixation. No cases of transient or permanent facial nerve weakness, wound dehiscence, infection, salivary fistula, or sialocele were observed. Scars were esthetically acceptable, with no patients reporting visible marks during follow-up. Conclusion: The RMA provides excellent access and visualization for anatomical reduction and rigid fixation of condylar fractures. It ensures favorable functional and esthetic outcomes with minimal complications, establishing it as a safe and reliable technique for managing condylar and subcondylar fractures.

Background and Objectives: Mandibular fractures, often caused by trauma, can lead to significant functional and aesthetic impairments, including difficulty chewing and speaking, and facial deformities, especially when comminuted. This study compares bone density and thickness in patients with comminuted mandibular fractures resulting from gunshot wounds, using advanced radiological methods to determine treatment efficacy and inform clinical decisions. Subjects and Methods: This retrospective study compared the treatment of comminuted mandibular fractures resulting from gunshot wounds at Sana'a Military Hospital. The study included patients who underwent open or closed reduction, and demographic data, injury characteristics, and post-treatment examinations were collected. Bone density and thickness were measured using cone-beam computed tomography (CBCT) or CT scans, and statistical analysis was performed to compare the two groups. Results: The study included five patients in each group who underwent intermaxillary fixation (IMF) and open reduction internal fixation (ORIF). The age distribution of patients was heterogeneous, with 30% between 22 and 24 years old, 20% between 25 and 27 years old, 30% between 28 and 30 years old, and 20% over 30 years old. Malunion was the most common complication, followed by bone loss in 30% of patients. No significant differences in bone density and thickness were observed between the IMF and ORIF groups at the site of injury. Conclusion: Ultimately, a patient's previous bone density is the determining factor in determining the appropriate treatment for a jaw fracture and is not a criterion for comparison between IMF and ORIF. Although both treatments have risks and benefits, the success of the outcome depends on the quality of the underlying bone to ensure stable healing. Peer Review History: Received 6 August 2025; Reviewed 12 September 2025; Accepted 22 October; Available online 15 November 2025 Academic Editor: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, sally.elzahaby@yahoo.com Reviewers: Dr. Mahmoud S. Abdallah, University of Sadat city, Egypt, dr_samy777@yahoo.com Dr. Mohamed Salama, Modern University for Technology & Information, Egypt, salama47@yahoo.com

Background: Pediatric mandibular fractures present unique challenges due to the presence of developing tooth buds, evolving occlusion, and the dynamic growth potential of the jaw. Management must balance achieving stable fixation with preserving long-term growth and function, necessitating a departure from standard adult protocols. Aim: This article aims to present and evaluate a conservative, interdisciplinary approach to managing pediatric mandibular fractures, focusing on techniques that minimize iatrogenic harm to dental and growth structures while ensuring effective healing. Methods: The methods are illustrated through a series of case studies (ages 1.5 to 16 years) involving mandibular fractures. The primary technique involved closed reduction using a custom-molded impression compound splint secured with circummandibular wiring, often combined with bridle wiring for concomitant dental injuries. This approach is contrasted with other methods like intermaxillary fixation (IMF) with interdental hooks in older children. Results: The presented technique proved highly effective across all cases. It provided stable, non-rigid fixation, achieved satisfactory fracture alignment, and facilitated uncomplicated healing. Key outcomes included the restoration of normal occlusion, rapid return to function, and the absence of complications such as infection or injury to tooth buds. The method was also noted for its procedural efficiency, cost-effectiveness, and ease of removal. Conclusion: A conservative strategy utilizing impression compound splints and circummandibular wiring is a safe, reliable, and biologically sound option for pediatric mandibular fracture management. Its success underscores the critical importance of an interdisciplinary team integrating dental, surgical, radiological, and nursing expertise to optimize outcomes for the growing patient.

Fractures in children are rare. The mandibular fracture incidence among children ranges between 0.6% and 1.4%. We report a case of a six-year-old with left chin pain. The patient had a history of falling from a motorcycle in a single accident that was not accompanied by bleeding from the mouth, nose, or ears. The patient’s father reported that the child did not experience syncope, vomiting, or drowsiness. Upon physical assessment, the child's vital signs were within normal ranges, and they were completely conscious. A mandibular fracture-like abnormality was discovered during a craniofacial assessment. The patient was treated with interdental wiring and intermaxillary fixation under general anesthesia. The child underwent interdental wiring and intermaxillary fixation under general anesthesia. The management was carried out in a district hospital, where limitations in resources and facilities necessitated the selection of a simpler and less invasive treatment approach. Even with these problems, the treatment plan that was worked for this child with a broken mandible.

BACKGROUND Maxillofacial fractures represent one of the most common forms of traumatic injuries, affecting both function and aesthetics, and are associated with significant morbidity and long-term sequelae. The incidence and distribution of these fractures vary considerably depending on demographic, socioeconomic, and geographic factors. This retrospective study from a single center aimed to evaluate the presentation, imaging findings, and outcomes in 195 patients with maxillofacial fractures treated with closed reduction or open reduction with internal fixation (ORIF). MATERIAL AND METHODS Clinical and radiographic data from 195 patients were reviewed, including age, sex, etiology, fracture site, and treatment modality. Fractures were managed with ORIF using titanium miniplates and screws, intermaxillary fixation (IMF) with screws and elastics, dental splints for selected pediatric cases, or closed reduction for midfacial fractures. Statistical analysis included chi-square or Fisher's exact tests, with P<0.05 considered significant. RESULTS The most common cause of injury was traffic accidents (63.1%), followed by assaults (19.5%) and falls (17.4%). Mandibular fractures were most frequent, particularly in the parasymphysis (29.2%) and symphysis (24.6%) regions. ORIF was performed in 75.4% of cases, IMF in 23.1%, and splints in 9.7%. Significant associations were found between fracture etiology, sex, and treatment modality (P<0.05). CONCLUSIONS Maxillofacial fractures primarily affect young men and are predominantly caused by traffic accidents. Mandibular fractures, especially in the parasymphysis and symphysis regions, are the most common type, and often require ORIF. These findings emphasize the importance of road safety measures and trauma care resources in regions with limited healthcare access.

While temporomandibular joint (TMJ) dislocations can cause significant pain and anxiety for patients, this was not the case for an 18-year-old woman who presented for an assessment by the oral and maxillofacial surgery team at the Queen Elizabeth Hospital in Birmingham. This patient had a year-long history of chronic bilateral anterior TMJ dislocation with severe resorption of the condylar heads. Relocation of bilateral TMJ with intermaxillary fixation was performed in theatre under general anaesthesia. Owing to the significant amount of resorption of condylar heads, the patient may require TMJ replacement surgery in the long term. TMJ dislocations can be difficult to diagnose. This case highlights the importance of a thorough clinical and radiographic examination to aid diagnosis. A delayed diagnosis and presentation can have a lifelong impact on patients. It can further increase the difficulty of management for practitioners. CPD/Clinical Relevance: This case report assists clinicians with the early identification and management of acute TMJ dislocations.

Patients satisfying the inclusion and exclusion criteria underwent arch bar application followed by either closed reduction or open reduction with internal fixation. Pre-operatively: OHI, GI, radiographically displacement, no. of fractures, Perioperatively: Duration of procedure, glove perforation, wire prick injuries, screw loosening/wire breakage, stability, and comfort intraoperatively. Postoperatively: OHI index and GI index, screw loosening/wire breakage, arch bar removal time and glove perforation, wire stick injury, root perforation. Chi-square test was used for categorical data in tabular and graphical forms. A statistically significant difference was observed in the postoperative OHI score, GI score, mean placement time, and mean removal time between Group A and Group B. The stability of the arch bar was matched between the groups. Screw loosening was non significant, Glove perforation was significant between Group A and B. Wire stick injury was non-significant between group A and B. The Hybrid Arch Bar proved to be superior to Erich's Arch Bar in terms of time efficiency, stability, comfort, and oral hygiene. Overall, the benefits of the Hybrid Arch Bar outweigh its disadvantages.

Sagacity of surgical selectivity: a retrospective analysis of occlusal outcome and intermaxillary fixation use in midface fracture fixation.

"Comparison of the efficacy of Erich arch bars, IMF screws and SMART Lock Hybrid arch bars in the management of mandibular fractures- A Randomized clinical study".

Introduction Recently, digital technologies have become common in clinical dental practice, which may provide benefits to clinicians and patients. This study investigated how water absorption affected the mechanical properties of three-dimensionally (3D)-printed surgical splint materials used to position bones during orthognathic surgery. Methods Two 3D-printing materials, Dental LT Clear (Formlabs) and Splint (SprintRay), as well as a conventional acrylic resin (Unifast III, GC), were purchased for this study. We prepared wire (2 × 2 × 25 mm) and disc-shaped (14 mm diameter and 2 mm in thickness) specimens via 3D-printing or pouring into silicon molds. All materials were subjected to the ISO 4049 three-point bending test, and the water absorptions of samples immersed in artificial saliva for 28 days were calculated as per ISO 10477. Changes in mechanical properties (hardness, and the modulus of elasticity) were evaluated via nanoindentation testing. Chemical parameters were determined using Fourier-Transform Infrared Spectroscopy (FTIR). The data were compared using ANOVA and the Tukey multiple comparisons test. Results The bending strengths and elongations of both 3D-printed materials were significantly greater than those of conventional acrylic resin. The FTIR data indicated that the water absorptions of both 3D-printed materials were significantly greater than those of conventional PMMA (polymethyl methacrylate)-based resin. The hardness and elastic modulus values of both 3D-printed materials (obtained using the nanoindentation test) decreased significantly as the immersion period rose; those of the conventional acrylic resin did not. Discussion The improved mechanical properties of 3D printed materials would demonstrate greater resistance to the stresses imparted by the muscles associated with functional mandibular movement, while also reducing the risk of splint chipping during intermaxillary fixation. On the other hand, there is concern that the stability of the mechanical properties of 3D printed materials may be compromised by water absorption in moisture-rich environments. Conclusion Although 3D-printed materials exhibit superior mechanical properties, their water absorption and extent of degradation on immersion in artificial saliva were higher than those of a conventional PMMA-based resin.

Facial fractures are a significant aspect of pediatric trauma cases. The impact of intermaxillary fixation (IMF) using screws on dental development, particularly in pediatric patients undergoing primary and mixed dentition, remains a subject of concern. This study aims to evaluate the long-term effects of IMF screws on tooth bud development in pediatric patients. A retrospective review was conducted of patients aged 3 to 12 who underwent facial fracture surgery using IMF screws between January 2010 and May 2024. Out of 45 patients, 9 were included based on inclusion criteria. The study assessed fracture localization, treatment methods, and follow-up outcomes through surgical reports, radiographs, and clinical evaluations. The mean age of the patients at the time of surgery was 7 years. Most fractures were localized in the mandible, with parasymphyseal and condylar regions being the most common. IMF screws were used in 8 cases, with durations ranging from 13 to 22 days and a mean follow-up period of 7.4 years. Eruption issues were noted in 2 patients, potentially related to fracture lines or other factors. No malformations, developmental delays, or eruption problems were observed in maxillary teeth. The use of IMF screws did not result in significant dental complications in patients aged 3 to 12 years old. This study suggests that IMF screws can be a safe option for stabilizing pediatric facial fractures without adverse effects on dental development, supported by the extended follow-up period and the absence of major complications.

Mandibular fractures constitute 57% of all maxillofacial trauma cases, particularly in developing countries such as India. The treatment of mandibular fractures involves either open reduction and internal fixation (ORIF), or closed reduction which is intermaxillary fixation (IMF). These fractures diminish the mandible's load-bearing capacity and compromise the functional ability of the patient. Masticatory efficiency, which measures the effectiveness of chewing, is a key indicator of the functionality of a remodeled mandible. This study evaluates the masticatory efficiency and mandibular function as affected by open or closed reduction of mandibular fractures. In this study, 14 cases of mandibular fractures were divided into two groups, Group 1-open reduction; and Group 2-closed reduction. The following outcomes were evaluated; subjective evaluation of masticatory efficiency of chewing function questionnaire, occlusion was assessed clinically, and mandibular function was assessed by maximal interincisal opening, maximal protrusion, maximal lateral excursion, and maximal retrusion. Group 1 consisted of nine patients (64.29%), while Group 2 had five patients (35.71%). A significant difference was achieved in masticatory efficiency between Group 1 and Group 2 in Week 3 (0.025) and Week 6 (0.003). Mean values of Maximal Interincisal Opening (MOI) and their comparison at different intervals revealed that in Group 1, MIO values significantly improved from preoperative 19.69±6.60 to postoperative 33.11 ± 5.25 with p-value <.001. The study concluded that mandibular function, as measured by mouth opening and occlusion, is similar in ORIF and IMF. Although both groups'masticatory efficiency improved significantly subjectively and objectively as compared to their preoperative efficiency, significant differences were observed. However masticatory efficiency is higher in ORIF patients than in IMF patients after 6 weeks.

Maxillomandibular fixation (MMF) serves as a conventional approach for immobilizing jaws in the treatment of maxillofacial fractures. However, intermaxillary fixation poses challenges to nutritional status in the immediate postoperative phase, resulting in the depletion of water, fat, and protein reserves. The objective is to evaluate the variations in total protein and albumin levels at distinct intervals throughout the treatment duration, aiming to elucidate the impact of intermaxillary fixation on nutritional markers. A total of 144 patients with jaw fractures presenting to the Oral and Maxillofacial Surgery Department of Govt. Dental College, Calicut, necessitating maxillomandibular fixation, were enrolled irrespective of etiology. They were randomly allocated into two groups: the Nutrition Intervention Group (GROUP 1) and the Nutrition Non-intervention Group (GROUP 2). Biochemical parameters including total protein and serum albumin were assessed. Measurements were conducted on the day of MMF initiation, as well as after the 2nd and 4th weeks thereafter. Significant variations were observed in the protein and albumin levels, with an increase in group 1 and a decrease in group 2 patients following maxillomandibular fixation (MMF). This study highlights the significant impact of personalized nutritional intervention on total protein and albumin levels in patients undergoing maxillomandibular fixation (MMF) for jaw fractures. Compared to the non-intervention group, those receiving tailored dietary counselling showed marked improvements in both protein and albumin levels. This emphasizes the importance of individualized nutritional support during MMF, essential for tissue repair, immune function, and overall recovery.

Femoral vascular trauma is a distinctive condition for every patient that needs an individual special urgent care and management approach to reduce mortality in the golden hour. Nonetheless, the risk persists in polytrauma patients accompanied by maxillofacial injuries. This study documents life-threatening bilateral femoral injuries by a gunshot that was accompanied by maxillofacial trauma. Methods. In the emergency room of the field hospital at north of Iraq, a 35-year-old man was presented with a deteriorating condition due to multiple gunshot injuries. The patient was suffering from complete severance to the right and left superficial femoral arteries, left superficial femoral vein, femoral nerve, and maxillofacial injuries. Femoral blood vessels were first managed to stabilize the patient’s condition. Then, intermaxillary fixation and mandibular fracture were managed with screws for emergency and temporary fixation (by elastic, then by wires). One month postoperative, the patient revealed complete healing, but the patient suffered from intermittent lameness due to left femoral nerve injury. Conclusion. To the author’s knowledge, this is the first case report that documented the successful rescue of maxillofacial trauma associated with multiple gunshot femoral vessels severe injuries with an early return of the traumatic patient to his normal function.

Mandibular condyle dislocation into the middle cranial fossa: First report of CAS-guided surgical management.

A Novel In-Office CAD-CAM Designed Device for Intermaxillary Fixation in Patients Treated With Aligners for Orthognathic Surgery

This retrospective study assessed the long-term outcomes of closed treatment (CT) using intermaxillary fixation (IMF) for bilateral subcondylar mandibular fractures. It included 30 patients treated with IMF for 6 weeks (study group) and 29 controls without temporomandibular joint (TMJ) disorders. Clinical assessments included mandibular function, pain, facial symmetry, and occlusion, while radiographic evaluations measured condylar deviation and vertical height reduction (VHR). Fracture severity and patient age at trauma were analyzed as influencing factors. The study group underwent 6 weeks of IMF treatment. Outcomes such as maximal mouth opening (MMO), mandibular and chin deviation, TMJ pain, masticatory muscle pain, condylar deviation, and VHR were compared with controls. Severe fractures were defined as VHR >5mm or angulation >45 degrees, with results stratified by age (younger than 12y versus older). MMO was similar between groups; however, the study group had higher rates of mandibular deviation (1.87±2.12mm versus 0.38±0.31mm; P =0.001), chin deviation (1.77±1.84mm versus 0.14±0.51mm; P <0.001), TMJ pain (13.33% versus 0%; P =0.041), and masticatory muscle pain (53.33% versus 0%; P <0.001). Severe fractures led to worse outcomes, while younger patients showed better recovery. CT with IMF achieves satisfactory long-term results with minimal complications but is influenced by fracture severity and age.

This study compares outcomes between surgical (open reduction and internal fixation [ORIF]) and conservative (intermaxillary fixation [IMF]) management approaches for mandibular angle fractures. A five-year multicenter retrospective analysis (2015-2019) was conducted on 64 patients treated across various hospitals in Western Libya. Patient demographics, fracture etiology, treatment modalities, healing duration, and complications were systematically evaluated. The results revealed that assaults/fights (56.3%) represented the predominant etiology, with males aged 20-29 years most frequently affected (71.9% male *p*=0.02 vs. females). Conservative treatment with IMF demonstrated superior healing rates, with 96.8% of cases achieving union within 9 weeks versus 57.58% for surgical interventions ORIF (*p*&lt;0.001, x2 test). The overall complication rate was 10.9% (abscess formation and delayed union), with no statistically significant difference between the IMF (9.7%) and ORIF (12.1%) groups (p*=0.74). These findings suggest that fracture line characteristics (favorable versus unfavorable) should be the primary predictor of treatment success (*OR*=4.2, 95%CI: 1.8-9.3). IMF is optimal for stable, non-displaced fractures, while ORIF remains indicated for displaced /unstable patterns. The study provides evidence-based guidance for clinical decision-making in mandibular angle fracture management. Limitations include retrospective design and single-region data.