Use Of Intermaxillary Fixation Research Articles

Factors predicting oral and maxillofacial fractures after falling and factors predicting the duration of treatment.

The first objective of this study was to identify predictive factors for oral and maxillofacial fractures at the initial response to the patient. The second objective was to determine the factors influencing the incidence of treatment duration of more than 1 month using the information shown in the medical record. Hospital records from 2011 to 2019 were reviewed to identify patients who had sustained oral and maxillofacial injuries by falling or falling from a height. Patterns and types of oral and maxillofacial injury, injury severity, and background of the injury were collected from the hospital records. The variables independently associated with a treatment duration of more than 1 month were determined by logistic regression analysis. In total, 282 patients (150 men, 132 women; median age, 17.5 years) were selected for analysis. Maxillofacial fractures were observed in 20.9% of patients (59/282); among these, mandibular fractures were the most common (47/59). Logistic regression analysis showed that age (odds ratio [OR], 1.026), nighttime occurrence (OR, 2.192), and upper face injury (OR, 20.704) were independent predictive factors for having a maxillofacial fracture. Additionally, the number of injured teeth (OR, 1.515) and the use of intermaxillary fixation (OR, 16.091) were independent predictors of treatment duration of more than 1 month. These results may be useful in the initial management of maxillofacial injuries in terms of better-informing patients injured by falling their expected treatment duration and managing the psychological impacts of a long treatment duration.

Rigid versus non-rigid fixation for bilateral angle of mandible fractures: A 10 year perspective

BackgroundBilateral mandibular angle fractures are an uncommon occurrence. Optimal management of bilateral angle fractures is controversial and owing to the rarity of the presentation, limited evidence regarding fixation strategies exists. MethodsA retrospective chart review of patients treated at three tertiary hospitals in Western Australia between January 2008 and June 2018 was performed. Patient demographics, injury mechanism, fixation type and the use of intermaxillary fixation were recorded. Rigid fixation (increased plate thickness (>1mm), additional screws/plate length/additional plates) was compared against the complication rates between non-rigid fixation (Champy's load-sharing/mini-plate fixation principles). Primary end-points were complications requiring a return to theatre during the follow-up period. ResultsDuring the study period, 2458 patients were managed with open reduction internal fixation. Fifty-eight bilateral angle of mandible fractures were identified, representing 2.4% overall. Nine patients had a complication during follow-up with 8 requiring a return to theatre for treatment. Statistical analysis demonstrated no increase in complication in either group. ConclusionsThis study represents the largest review of patients with bilateral mandibular angle fractures. Given no increase in complication rates, it is suggested that the surgeons preference, incorporating fracture and patient factors be considered in determining the need for either rigid or non-rigid fixation for this particular fracture pattern.

Le Fort I osteotomy with segmentation for the treatment of maxillary dentoalveolar protrusion: a single-centre, 10-year outcome study

A retrospective study was conducted to evaluate the stability and complications of Le Fort I osteotomy with segmentation for the treatment of bimaxillary dentoalveolar protrusion. A total of 120 consecutive patients who had undergone orthognathic surgery between 2008 and 2017 at a single centre were recruited. Lateral cephalometric radiographs were taken before surgery, within 6 weeks after surgery, and at 2 years after surgery. U1–SN and U1–PP underwent mean uprighting of 8.7° and 9.6°, respectively, and mean relapse of 2.1° and 2.6°, respectively (both P < 0.05). The only significant risk factor for relapse was the use of intermaxillary fixation (risk ratio (RR) 1.2, P = 0.01). The most common complication was wound dehiscence (41.7%), which was a significant risk factor for wound infection (RR 3.3, P < 0.01) and fixation hardware exposure (RR 3.7, P < 0.01). Other common complications were gingival recession (40.8%), periodontal bone loss (40%), and blood loss requiring transfusion (26.7%), the latter of which was associated with the preoperative diagnosis of vertical maxillary excess (RR 2.4, P = 0.01). Some degree of relapse occurred in more than 90% of the patients by 2 years after surgery. The procedure is not without risks and complications but may be useful in severe cases.

A Comparative Analysis of Outcome of Open Reduction and Internal Fixation of Mandibular Fracture With or Without Intermaxillary Fixation

Aim: To evaluate the difference and functional outcome between open reduction and internal fixation (ORIF) and intermaxillary fixation (IMF) in mandibular fractures. Study Design: Retrospective study. Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Faryal Dental College, Sheikhupura, Lahore from 1st February 2019 to 31st January 2021. Methodology: One hundred and fifty seven patients treated for fractures of mandible and reviewed their prognosis based on use of intermaxillary fixation after reduction of fracture. The patients were divided into two groups; Manual reduction group without the intermaxillary fixation and the intermaxillary fixation group. Results: Good results have been obtained in most patients after mandible fracture reduction. However, complications occurred in 19 (27.5%) patients in group 2 after surgery. 6 patients had an infection, 4 patients had a wound dehiscence, and 4 patients had osteomyelitis. No loosening of the mounting bolts and/or crack of the mounting plates was observed. Correct occlusion was achieved using posterior arch wires and elastic rings in 2 malocclusion patients. Occlusion failed in two patients in Group 1 due to osteomyelitis, and the second operation was performed under general anaesthesia. The mean complication severity scores for Group 1 and Group 2 were 1.37 and 1.38, respectively, with no significant difference. Conclusion: Among the patients treated with manual reduction, 2 patients had malocclusion and 1 patient required a new surgery. Such a simple mandible fracture can give good results even with manual reduction without intermaxillary fixation. For a simple mandible fracture, only manual reduction without intermaxillary fixation or intermaxillary fixation was recommended for a short time. Key words: Complication, Fracture, Internal fixation, Mandible

How has COVID-19 affected surgical practice in Oral and Maxillofacial Surgery in the East Midlands, UK?

The impact on the provision of care within the NHS due to COVID-19 can not be understated. It has created various challenges for Oral and Maxillofacial Surgeons due to the high-risk nature of working within this specialty. The aims of this study were to identify the ongoing clinical activities at the height of pandemic, the guidance issued to staff regarding the use of personal protective equipment and the changes to maxillofacial practice. A prospective analysis was commenced within six Oral and Maxillofacial Surgery units in the East Midlands, UK with data being collected by means of a 10-item questionnaire relating to changes in patient care during this time. The responses were analysed to identify compliance with the national guidance produced by the British Association of Oral and Maxillofacial Surgeons.An 87% response rate was obtained (26 respondents from 30 invitations). 73.1% of participants confirmed all surgical members of staff were offered fit tests for FFP3 masks. All units reported a continuation of Head and Neck cancer and emergency operations with a complete reduction in TMJ and orthognathic surgery. FFP3 masks were the most popular masks used for theatre activity whilst FFP2 and surgical masks were more widely used for examining patients and performing procedures in the emergency department. Changes in maxillofacial practice included the use of local flaps compared to free flaps, use of intermaxillary fixation (IMF) where appropriate for craniofacial trauma and routine COVID-19 testing for all inpatients.

Factors influencing the long-term hospitalization of bicyclists and motorcyclists with oral and maxillofacial injuries.

Because bicyclists and motorcyclists with oral and maxillofacial injuries often suffer from disabilities requiring long-term treatment, reducing the severity of such injuries is a valuable objective for improving these people's quality of life (QOL). The aims of this study were, first, to present the prevalence and patterns of oral and maxillofacial injuries of bicyclists and motorcyclists and to compare the features of these injuries and, second, to determine the factors contributing to long-term hospitalization for these patients and to propose effective preventive measures. This was a single-center retrospective analysis. Hospital records from 2011 through 2018 were reviewed for all patients who had sustained oral and maxillofacial injuries in bicycle or motorcycle collisions and had presented at a university hospital which was the only hospital in the region attended 24hours per day by oral and maxillofacial surgeons. Characteristics of the oral and maxillofacial injuries, injury severity, and factors influencing the length of hospitalization were examined. Records of 130 patients (82 bicyclists and 48 motorcyclists) with a mean age of 28.0years were analyzed. Thirty-three patients (25.4%) had maxillofacial fractures, with 41 fracture lines while 103 patients (79.2%) had dental injuries and 57 patients (43.8%) had soft-tissue injuries. The distribution and prevalence of oral and maxillofacial injuries were similar for bicyclists and motorcyclists. However, motorcyclists had significantly higher Abbreviated Injury Scale (AIS) scores for facial injuries and the maximum AIS score than did bicyclists. According to a multiple regression analysis, the number of fracture lines and the requirement for intermaxillary fixation were independent factors influencing long-term hospitalization (standard regression coefficients: 6.795 and 6.715, respectively; P<.001). The number of fracture lines and the use of intermaxillary fixation were independent factors influencing long-term hospitalization of both bicyclists and motorcyclists with oral and maxillofacial injuries.

Reverse umbrella technique – percutaneous reduction of frontal bone fracture using an intermaxillary fixation screw device

Fractures of the frontal sinus account for approximately 5%–15% of all maxillofacial fractures with a slight male preponderance.1 The standard management involves an access coronal flap for open reduction and internal fixation, but this has some unwanted risks such as scar, alopecia, paraesthesia, and facial nerve weakness.2 We report a safe and effective percutaneous technique for closed reduction of a non-comminuted isolated anterior table fracture of the frontal sinus with the use of intermaxillary fixation (IMF) screws under image intensifier guidance.

Comparison of different treatment techniques in the mandibular condyle fracture.

Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have discussed for the optimal treatment method, the issue remains controversial. In this study, we aimed to compare conservative techniques in the mandibular condyle fractures. Twenty four unilateral condyle fracture patients aged between 18 and 48 years were treated according to one of three different modalities. Bracketing, arch bar or mini screw was applied to all non-surgery patients to obtain IMF. Eight patients were treated with only IMF meanwhile eleven patients were treated with one or double-sided amplifier occlusal splint according to the status of fractured segments, in addition to IMF. Remaining five patients have undergone open reduction and fractured segments immobilized with mini plates. Pre- and post-operative images were recorded with a computerized tomography device. Clinical and radiological examinations were performed by orthodontists and surgeons at baseline and at 6 months of treatment. The condyle lengths of the patients with unilateral fracture after recovery were compared with the unaffected side. The length between the most protruding point of the condyle and the mandible was measured and the length difference was only 5.94 mm in patients who were treated by IMF. The length difference of patients who used brackets and splints was 3.36 mm (p<0.05). The length difference of patients who were repaired by plate screws was 1.80 mm (p>0.05). However, there was no statistically significant difference (p>0.05) between the groups in the IMF, occlusal splint and IMF and mini plate groups, between the trauma side and the opposite side. None of the patients developed ankylosis, open mouth, limitation of mouth opening, facial asymmetry, laterognathia, and retrognathia. The occlusion of the patients who were not known to have pre-trauma occlusions were directed, repositioned and provided an appropriate occlusion. The use of IMF with an occlusal splint is a more conservative and acceptable treatment modality than open reduction in selected cases.

Comparison of Erich arch bar versus embrasure wires for intraoperative intermaxillary fixation in mandibular fractures

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. 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. Chi-squared test and unpaired t test analyses was run on IBM SPSS 21.0 version (2015) software. Mean time for placing embrasure wire (3.48min) was significantly less than that for Erich arch bar (48.08min). 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. 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.

Airway management through submental derivation: a safe and easily reproduced alternative for patients with complex facial trauma.

ObjectivesAirway management in patients with panfacial trauma is complicated. In addition to involving facial lesions, such trauma compromises the airway, and the use of intermaxillary fixation makes it difficult to secure ventilation by usual approaches (nasotracheal or endotracheal intubation). Submental airway derivation is an alternative to tracheostomy and nasotracheal intubation, allowing a permeable airway with minimal complications in complex patients.Materials and MethodsThis is a descriptive, retrospective study based on a review of medical records of all patients with facial trauma from January 2003 to May 2015. In total, 31 patients with complex factures requiring submental airway derivation were included. No complications such as bleeding, infection, vascular, glandular, or nervous lesions were presented in any of the patients.ResultsThe use of submental airway derivation is a simple, safe, and easy method to ensure airway management. Moreover, it allows an easier reconstruction.ConclusionBased on these results, we concluded that, if the relevant steps are followed, the use of submental intubation in the treatment of patients with complex facial trauma is a safe and effective option.

MAXILLOMANDIBULAR FIXATION USING ORTHODONTIC MINI-IMPLANTS IN MANAGEMENT OF MANDIBULAR FRACTURES

INTRODUCTION: The use of intermaxillary fixation (IMF) in the treatment of maxillofacial trauma represents the cornerstone of fracture reduction and immobilization. Many modalities of IMF have been described. Recently, to overcome the cumbersome procedure of tooth borne appliances, miniimplants have been introduced into clinical practice. OBJECTIVES: To evaluate the effectiveness of using mini-implants for IMF for the treatment of mandibular fractures. MATERIALS AND METHODS: This clinical trial was performed on ten patients with mandibular fractures. The diagnosis, duration of IMF, miniimplants site, bite force recovery, bone density around the fracture line and any associated complications were recorded. Clinical and radiographic follow-up examinations were performed immediately, 3 and 6 months post-operatively until fracture healing was complete. CONCLUSIONS: The use of mini-implants for IMF has shown to be a useful and safe modality to establish maxillo-mandibular fixation following mandibular fractures.

Assessing the need for a protocol in monitoring weight loss and nutritional status in orthognathic surgery based on patients experiences.

BackgroundTo investigate retrospectively the orthognathic surgery (OGS) patients experience in weight loss and the influence of gender, age, duration of the surgical procedure, length of hospital stay, location of surgery and use of intermaxillary fixation (IMF) or without IMF on postoperative weight loss.Material and MethodsA total of 4487 patients treated by OGS where all patients visited the outpatient clinic one, three and six weeks after the surgical procedure. After six weeks, patients filled out a questionnaire in which weight loss was addressed. The patients were asked to give an estimate of their experiences weight loss. The population was first divided in two groups weight loss and no weight loss.ResultsIn the weight loss group there is no significant difference in weight loss between patients with IMF and patients without IMF. In the weight loss group there were significantly more females then males. Further, in the subgroup IMF the operation time was significantly longer compared with the subgroup without IMF. The other parameters including age and hospital stay were not different in the groups.ConclusionsIMF in orthognathic treatment does not result in a difference self-reported loss of body weight compared to patients without IMF. Treatment protocols should include pre- and post-operative dietician consultations and possible indications for medical nutrition and vitamins. Key words:Assessing, protocol, weight loss, experiences, orthognathic surgery.

Self-tapping Intermaxillary Fixation Screw: An Alternative to Arch Bar.

The use of intermaxillary fixation (IMF) in the treatment of faciomaxillary fractures is the key factor for reduction and immobilization. Various techniques of IMF have been described in the past and recently IMF screws have been introduced. This technique has various advantages, including ease of use, less time consumption, less trauma to the surrounding soft tissues, and relatively reduced risk of needle stick injury. This study evaluates the efficacy of IMF screws over arch bar IMF before definitive fixation of facial fractures. This study is a randomized clinical study. Study population consists of 20 patients with mandibu-lar fractures requiring IMF with open reduction and reported to Department of Oral Surgery, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India between September 2012 and April 2015. Two groups were formed with 10 patients in each group. In the first group, IMF was achieved using the Erich's arch bar and wires. In the second group, IMF was achieved using self-tapping IMF screw. The patients were assessed for various parameters, such as the time required in minutes for the IMF stability of fixation, postoperative occlusion, postoperative pain, periodontal health, oral hygiene, and incidence of needle stick injury. All the cases had stable IMF in both groups. At the end of 14th day, overall oral hygiene was poor in group I and good in group II, significant statistically (p = 0.031). Iatrogenic injury to tooth was absent in group I and present in 1 case in group II, not significant statistically (p = 0.305). Average time taken for the IMF in group I was 74.9 minutes, with the range of 58 to 88 minutes, and in group II was 16.1 minutes, with the range of 11 to 22 minutes, which is highly significant statistically (p = 0.001). Needle stick injuries were taken as positive if glove perforation was present and these were reported in four cases in group I, whereas in group II, no case had incidence of needle stick injuries, which shows significant statistically (p = 0.025). After this study, we can conclude that IMF self-tapping screw is a proven useful technique of IMF. Intermaxillary fixation is a safe and less time-consuming method but with various shortcomings and complications, which the surgeon must be aware of while providing treatment. Keywords: Erich's arch bar, Intermaxillary fixation, Self-tapping intermaxillary fixation screws.

A Detailed Analysis of Mandibular Angle Fractures: Epidemiology, Patterns, Treatments, and Outcomes

The purpose was to analyze mandibular angle fractures by examining epidemiologic trends and mechanisms of injury and to determine whether a statistically meaningful relation existed between certain treatment modalities and patient outcomes. A retrospective chart analysis was performed, and data were limited to 1 operator. Treatment variables were methods of fixation, postoperative intermaxillary fixation (IMF), and retention versus extraction of teeth in the line of fracture. Outcomes were rates of postoperative infection, fracture healing, and overall patient comfort. Analysis was performed using the Fisher exact test, Wald test, and χ(2) test, with a P value less than .05 considered significant. One hundred three patients were included in this study. The mean age was 30.4years, most patients were men, and most injuries occurred during physical altercations and on the left side of the face. The most common concomitant fracture was of the contralateral parasymphysis. A statistically meaningful relation was noted between methods of fixation and healing and overall patient comfort, with the Champy technique and reconstruction plate being associated with the highest rates of bony union and patient comfort. No statistically relevant correlation was found between methods of fixation and rates of infection. There was no statistically relevant link for extraction versus retention of healthy teeth in the line of fracture or use of IMF with patient comfort, postoperative infection, or fracture healing. Although the Champy technique and reconstruction plates were associated with better postoperative outcomes, such as patient comfort and fracture healing, these should not be used interchangeably. IMF and extraction versus retention of teeth in the line of fracture did not influence any of the outcomes.

Custom-Machined Miniplates and Bone-Supported Guides for Orthognathic Surgery: A New Surgical Procedure

Several surgical strategies exist to improve accuracy in orthognathic surgery, but ideal planning and treatment have yet to be described. The purpose of this study was to present and assess the accuracy of a virtual orthognathic positioning system (OPS), based on the use of bone-supported guides for placement of custom, highly rigid, machined titanium miniplates produced using computer-aided design and computer-aided manufacturing technology. An institutional review board-approved prospective observational study was designed to evaluate our early experience with the OPS. The inclusion criteria were as follows: adult patients who were classified as skeletal Class II or III patients and as candidates for orthognathic surgery or who were candidates for maxillomandibular advancement as a treatment for obstructive sleep apnea. Reverse planning with computed tomography and modeling software was performed. Our OPS was designed to avoid the use of intermaxillary fixation and occlusal splints. The minimum follow-up period was 1year. Six patients were enrolled in the study. The custom OPS miniplates fit perfectly with the anterior buttress of the maxilla and the mandible body surface intraoperatively. To evaluate accuracy, the postoperative 3-dimensional reconstructed computed tomography image and the presurgical plan were compared. In the maxillary fragments that underwent less than 6mm of advancement, the OPS enabled an SD of 0.14mm (92% within 1mm) at the upper maxilla and 0.34mm (86% within 1mm) at the mandible. In the case of great advancements of more than 10mm, the SD was 1.33mm (66% within 1mm) at the upper maxilla and 0.67mm (73% within 1mm) at the mandibular level. Our novel OPS was safe and well tolerated, providing positional control with considerable surgical accuracy. The OPS simplified surgery by being independent of support from the opposite maxilla and obviating the need for classic intermaxillary occlusal splints.

Current trends in use of inter-maxillary fixation in the management of mandibular fractures: A national survey

Results: Overall average delay from admission to surgery was 0.9 days and inpatient length of stay (IPLOS) was 1.8 days. Of the seven patients assessed as suitable for DSU; mean delay to surgery was 1 day, and IPLOS 1.6 days. Cost comparison and financial savings: Inpatient and DSU theatre costs are comparable at £213.64 and £211.69 per 15mins respectively. Potential inpatient bed-day earnings are £1831. There is a premium ’intermediate OMFS procedure’ Healthcare Resource Group tariff of £102.80 as DSU over inpatient. Conclusion: A conservative 10% of mandibular fractures can be safely managed as outpatients. This should increase as the DSU service gains experience handling more complex fractures. A business case can be made to establish a rapidaccess link to existing DSU lists to release inpatient beds in a safe manner on the basis of increased income and decreased expenditure.

Are Embrasure Wires Better Than Arch Bars for Intermaxillary Fixation?

To compare the outcomes of mandible fractures treated with open reduction and internal fixation versus adjunctive intermaxillary fixation (IMF) using 2 different techniques. We performed a retrospective medical record review. The medical records of consecutive patients with mandible fractures treated surgically with adjunctive use of IMF (embrasure wires vs arch bars) were reviewed for demographic data, etiology, fracture location, antibiotic use, and interval to repair. Specifically, the complications, including infection, malunion or nonunion, hardware failure, and wound dehiscence, were recorded. The data were analyzed using Student's t test and the chi-square test or Fisher's exact test, as appropriate. Statistical significance was set at P < .05. A descriptive cost analysis was also performed and compared with those from previously published studies. The data from 86 subjects were included in the present study. Of the 86 subjects, 33 were in the embrasure wire group and 53 in the arch bar group. Of the patients in the arch bar group, 26% had complications compared with 15% in the embrasure wire IMF group. No statistically significant difference between the groups in terms of infection (P = .63), hardware failure (P = .75), malocclusion (P = .85), and nonunion (P = 1.0). However, the cost of arch bar placement and removal was approximately $2,672 more than the placement of embrasure wires. Patients treated with embrasure wire IMF had slightly better clinical outcomes compared with those treated with arch bar IMF. Also, the cost reduction for patients treated with embrasure wire IMF was significant.

A Comparative Study of Intermaxillary Fixation and Manual Reduction at Open Reduction and Internal Fixation of Mandibular Fractures

Purpose: The purpose of this study is to evaluate the difference between open reduction and internal fixation (ORIF) and intermaxillary fixation (IMF) of mandibular fractures. Methods: A total of one hundred twenty-seven patients who were treated for mandibular fractures at Chosun University Dental Hospital, from January 2008 to December 2010, and analyzed their prognoses based on the use of IMF at the time of fracture reduction. The patients were divided into two groups; the manual reduction group without IMF and IMF group. Results: After reduction of the mandibular fracture, good results were obtained with majority patients. Nonetheless, seven patients (13.0%) in manual reduction method without arch bars or IMF, developed complications after surgery. Three patients underwent IMF due to occlusal instability after surgery, while one patient underwent re-operation. Thus, a significant difference was not observed between the IMF and manual reduction groups. Conclusion: Manual reduction and IMF at mandibular simple fracture could produce good results. In case of mandibular simple fracture, it was recommended with only manual reduction without IMF or IMF during a short period.

Submental intubation: a retrospective review of 45 cases

Airway management in patients undergoing maxillofacial surgery requires special consideration. A number of options including oro- or naso-tracheal intubation and tracheostomy are available. Submental intubation is now a recognised method of airway control during maxillofacial surgery. It provides a secure airway and does not interfere with maxillomandibular fixation or access to naso-orbito-ethmoid fractures. It avoids potential complications associated with nasotracheal intubation and tracheostomy in patients with multiple facial fractures, and obviates the need to alternate between oral and nasal intubation intra-operatively. This is a ten year retrospective review of patients who underwent submental intubation in a Regional Oral and Maxillofacial Surgery Department. The following variables were recorded: patient gender and age, preoperative diagnosis, duration of intubation, and complications associated with the intubation technique. Submental intubation was performed 45 times on 45 patients. There were no complications relating to the submental intubation procedure. Submental intubation should be considered as an option for airway management in selected cases of craniomaxillofacial surgery. It is a quick and safe technique with minimal morbidity and a low complication rate. It allows access to the maxillofacial skeleton intra-operatively and does not preclude the use of intermaxillary fixation.

A Comparison of Anterior vs Posterior Isolated Mandible Fractures Treated With Intermaxillary Fixation Screws

To compare complication rates after use of intermaxillary fixation (IMF) bone screws for anterior (ie, symphyseal/parasymphyseal) and posterior (ie, body and angle) mandible fractures. A retrospective analysis of isolated mandible fractures treated with intraoperative IMF bone screws at 2 major level 1 trauma centers within the Department of Otolaryngology-Head and Neck Surgery at the University of Minnesota. From January 1, 2003, through January 31, 2006, we accrued 53 patients with 67 isolated mandible fractures treated with intraoperative IMF bone screws. These patients had at least 6 weeks of follow-up. Twenty-one patients had anterior mandible fractures and 32 had posterior mandible fractures. In the anterior group, there was 1 incident of wound dehiscence, resulting in a total complication rate of 5%. In the posterior fracture group, there was 1 infection (3%), 4 malunions/malocclusions (12%), and 1 nonunion (3%), for an overall complication rate of 19%. The difference between groups for malocclusion rates (12% vs 0%) was significant (P < .001). The IMF bone screw system has a superior speed and safety profile. It produces better occlusion results in anterior mandible fractures and might have a lower overall complication rate compared with arch bars. Given this, IMF bone screws are the preferred modality of intermaxillary fixation in properly selected mandible fractures.