Weeks Of Maxillomandibular Fixation Research Articles

To Determine Mean Change In Weight Of Patients Undergoing Maxillomandibular Fixation

Objective: Optimum management of patient needs is the most important step for the restoration of form and function. Maxillomandibular fixation is one of the treatment modalities used very frequently in maxillofacial surgery. This study aims to determine the mean change in weight in patients undergoing Maxillomandibular Fixation. Methods: This observational cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery Foundation University Medical College from 27th April 2018 to 22nd January 2019. This study included patients male and female, who presented with maxillofacial trauma, orthognathic surgery and procedures in which MMF ( Maxillomandibular fixation ) was indicated were included in this study. Pre-operative weight was measured in kilograms with an analogue weight machine and designated as W1. Patients were advised to a liquid diet and kept on follow-up. After four weeks of MMF again weight of the patient was measured and designated as W2. Follow-up was done through the patient's contact number. Results: In this study, the mean weight of patients preoperatively was 59.46±12.23 Kg. The postoperative mean weight of patients was 57.81±11.58 Kg. A decrease of 1.65 Kg was seen in the patient’s weight postoperatively. No significant difference was seen for weight change in patients postoperatively with age, gender, educational status, occupational status, socioeconomic status and an indication of MMF. Conclusion: Results of this study showed weight loss in patients who underwent maxillomandibular fixation. This factor should be considered during the perioperative period to prevent postoperative complications, postoperative weight loss, and malnutrition of patients undergoing maxillomandibular surgery and reflect the need for guidance on diet postoperatively, mainly directed to frequency of feeding and high protein liquid diet and nutritional supplements. Keywords: Body mass index, Facial trauma, Maxillomandibular Fixation, Mandibular fracture, Open reduction internal fixation, Orthognathic surgery, Weight loss.

Quality of life in patients with mandible fracture treated with closed reduction using Erich arch bar vs intermaxillary fixation screws

The aim of this study is to compare the quality of life (QoL) in patients with mandibular fractures undergoing closed reduction with conventional arch bar versus intermaxillary fixation screws at 4th week follow up. Objective is to assess the quality of life by GOHAI index in the 2 groups.A prospective analytical study was conducted on 50 patients between the age group of 18-50 years with dentate mandibular fractures as the study sample. Patients were divided into two groups. The control group underwent four weeks of maxillomandibular fixation with arch bar and test group underwent closed reduction with intermaxillary fixation screws. Both techniques were compared in terms of GOHAI index for assessment of QoL. QoL scores were recorded at 4th week follow up. Oral hygiene, operator injuries and time taken for the procedure was also observed on day of procedure and 4th week after procedure.The GOHAI’s total value score of ≤ 50 indicates a good QoL, 51-56 indicates a fair living quality, and 57-70 demonstrates the poor QoL. In this study the mean rank for the control group was found to be 43.5 and 35.36 for the test group suggesting a good QoL for the test group. Conclusion: There was significant difference between QoL of control group and test group, with test group (IMF Screws) having better QoL. Arch bar placement (control) is time consuming and had more oral hygiene problems when compared to IMF screws. Operator injury is less in IMF groups, but chances of dental complications are higher.

Is the prevention of condylar sag with maxillomandibular fixation the key to functional reconstruction of a mandibular disarticulation resection?

The aim of this study was to evaluate the long-term outcomes of the use of the free fibula flap for reconstruction with mandibular disarticulation resections. A retrospective chart cohort review was performed in patients reconstructed with a fibula free flap for a mandibular disarticulation resection at an academic tertiary care institution over a 5-year period. Twenty-four patients were included in the study. Fourteen patients were treated for benign pathology, and 10 cases were malignant. Average follow-up was 20 months. Virtual surgical planning/3-dimensional models were used in all cases. Maxillomandibular fixation (MMF) with surgical wires was used in 65% (n = 13/20) of the dentate patients. Average maximum interincisal opening was 28.2 mm in patients receiving radiation and 38.7 mm in the nonradiated group (P = .01). No patient developed joint ankylosis. Neocondyle position was an average of 11.7 mm from condylar fossa, radiographically. Seventeen of the dentate patients (85%) had reproducible class I occlusion. Occlusion was superior in patients placed into MMF compared with those with elastics or no MMF (P = .06) and independent of the position of the neocondyle (P = .19). The vascularized fibula flap can be used to provide functional reconstruction of the mandibular condyle defect. The use of at least 2 weeks of MMF maintains an adequate occlusion irrespective of the fibula-glenoid fossa position. The neocondyle does not need to directly abut the articular disc or fossa for adequate functional outcomes.

Nutritional intervention during maxillomandibular fixation of jaw fractures prevents weight loss and improves quality of life

Maxillomandibular fixation (MMF) for the management of jaw fractures leads to compromised nutritional intake and consequent weight loss and poor quality of life (QoL). The present study aimed to evaluate the effectiveness of a home-based dietary plan to prevent weight loss, and its effect on the QoL of patients who underwent four weeks of MMF for the treatment of maxillofacial fractures. A total of 50 patients were randomised into nutritional intervention (Group1) and non-intervention groups (Group 2). Patients in Group1 were counselled by a dietitian and given a diet plan. Patients in Group 2 were advised to take a liquid diet of their own choice in the form of shakes, juices, and milk, along with protein supplements. Patients in Group1 lost significantly less weight than those in Group 2 (p=0.001) at week four of follow up. Group1 patients had significantly better oral health-related QoL in the ‘physical pain’ domain during the two weeks of MMF, and in the ‘physical discomfort’ and ‘psychological disability’ domains two weeks after the release of MMF. They had significantly better nutrition-related QoL in all the domains during the two weeks of MMF and, except for the ‘physical’ domain, also during the two weeks after its release. Individual home-based diet plans effectively helped the patients maintain their weight and improved QoL.

Weight Changes (in kg) in Mandible Fracture Patients After IMF: A Prospective Study

Background: This prospective study is done to assess weight loss due to maxillomandibular fixation (MMF) in patients who have undergone treatment for maxillofacial fractures. This fixation method is a closed reduction technique that can interfere with normal nutrition intake of solid and semisolid foods and thus can result in weight loss and malnutrition. Therefore, in this study we explain the degree and pattern of weight loss in patients treated with MMF. Materials and Methods: We treated 300 patients for 4 to 6 weeks of MMF. We measured and compared the weight before and after MMF. Results: The loss of weight was statistically significant ( P < .001) with MMF treatment. Conclusion: MMF caused mild to moderate malnutrition in some cases so protein diet was recommended to such patients post treatment.

A Comparative Study of the Changes in Condylar Position after Mandibular Setback Using Bilateral Sagittal Split Ramus Osteotomy between Surgery-After and Surgery-First Orthognathic Surgery

Statement of the Problem: Complication after Extraoral Vertical and Intraoral Oblique Osteotomy have been reported but in a comprehensive manner. Although intuitively the profile of complications after Intra Oral Vertical Ramus Osteotomy (IVRO) would be similar to subcondylar osteotomy, the technique of the two procedures are different, and thus unfavorable outcome after surgery also may differ. The aim of this study was evaluate the morbidity and complications following correcton of mandibular deformity by IVRO. Material and Method: A prospective study was undertaken of 271 consecutively treated orthognathic surgical patients with mandibular deformity(without mandibular deficiency). Each patients was treated by bilateral IVRO with 2 Weeks of maxillo-mandibular fixation and no interosseous fixation of proximal segment. Method of Data Analysis: Postoperative stability ,immediately after surgery ,at 6 months , and at 12 months after surgeryweremade. Complications consist of vascular complications, nerve injury, infection, condylar luxation andbonehearingwere assessedby retrospective individual chart review. Results: The mean blood loss was 47g and no severe bleeding during operation. There was no wound infection and avascular necrosis after surgery. Inferior alveolar nerve neurosensory disturbance remained 2 operative sites but was not permanent. Malocclusion after surgery was manifest by either relapse or anterior open bite occurred in 3 patients. Condylar dislocation occurred 1 patient. Conclusion: Our studies indicated that surgical correction of mandibular deformity by IVRO had a beneficial effect not only on occlusion but also upon complication after surgery.

Transoral Miniplate Fixation of Mandibular Angle Fracture with and without 2 Weeks of Maxillomandibular Fixation: A Clinical Trial Study

Background and Objectives The ideal line of osteosynthesis in mandibular angle fractures indicates that a plate might be placed either along or just below the external oblique ridge. Some authors believe that using one miniplate at this line at the mandibular angle region provides sufficient strength to stabilize the fracture but others imply a second plate is required. Such controversies exist in the use of maxillomandibular fixation (MMF). The intention of the present study was to compare efficiency and complications of using one miniplate with and without MMF in mandibular angle fractures. Methods and Materials Forty patients with facial trauma with mandibular angle fractures including displaced and unfavorable fractures were categorized into two groups of 20 persons. In all patients, one miniplate was placed on the external oblique ridge. In the first group, patients had light maxillomandibular elastic bands just after surgery but no rigid MMF. In the second group, patients had rigid MMF for 2 weeks after surgery. Patients were followed to evaluate complications and treatment efficiency. Conclusions Our study showed that use of a single miniplate in the external oblique ridge is a functionally stable treatment for all types of angle fractures (including displaced and unfavorable fractures) except comminuted and long oblique fractures, which were not included in our study. Use of postoperative MMF did not improve the results.

Treatment of mandible fractures using resorbable plates with a mean of 3 weeks maxillomandibular fixation: a prospective study

In this study, a 2.5-mm resorbable plating system (Inion CPS, Tampere Finland) was assessed for the fixation of mandibular fractures with 3 weeks of maxillomandibular fixation. Fifty mandibular fractures in 34 patients (32 males, 2 females) with a mean of 20.8 days of maxillomandibular fixation (MMF) were included in this study. The 2.5-mm resorbable plates were adapted along Champy's line of ideal osteosynthesis and secured with four 8 × 2.5 mm monocortical resorbable screws. All patients were followed for a minimum of 6 weeks with an average long-term follow-up of 10 months. The incidence of soft tissue infection, nonunion, malunion, malocclusion, osteomyelitis, nerve injury, and tooth damage was prospectively assessed. Primary bone healing was achieved in 100% of cases. Ten minor complications (20%) were observed: 5 soft tissue infections (10%), 4 plate dehiscences (8%), and 1 malocclusion (2%). No evidence of malunion, nonunion, osteomyelitis, plate fracture, or iatrogenic dental or nerve injury was noted; no readmission or reoperation was necessary. The Inion 2.5-mm resorbable plating system along Champy's line of ideal osteosynthesis plus 3 weeks of MMF is a viable option for the treatment of mandible fractures.

A Prospective Study of 3 Treatment Methods for Isolated Fractures of the Mandibular Angle

The purpose of this investigation was to evaluate treatment outcomes prospectively when isolated fractures of the mandibular angle are treated by 1) nonrigid fixation that includes 5 to 6 weeks of maxillomandibular fixation, 2) nonrigid but functionally stable fixation using a single miniplate, and 3) rigid fixation using 2 miniplates. All patients treated for isolated fractures of the mandibular angle at Parkland Hospital over a 12-year period were treated by 1 of the 3 methods sequentially assigned. Demographic, fracture characteristic, and treatment and outcome data were prospectively collected and statistically analyzed to determine whether the 3 treatments produced different outcomes. One hundred eighty-five patients had sufficient follow-up for inclusion in this study. There were no significant differences in demographic data for the 3 groups. There were significant differences in treatment outcomes for several variables, including the amount of time it took to perform the surgery and postoperative wound problems. The use of single miniplate was the easiest to perform and was associated with the lowest number of complications.

Equivalence Randomized Controlled Trial of Bioresorbable Versus Titanium Miniplates in Treatment of Mandibular Fracture: A Pilot Study

The present study was undertaken to test bioresorbable fixation versus titanium for equivalence in terms of clinical union and complications using the American Association of Oral and Maxillofacial Surgeons parameters of care. The study design was a randomized, controlled, equivalence trial. A total of 40 patients were enrolled and allocated to the titanium group and bioresorbable group using a computerized randomization table. All were plated using standard plating principles. In the bioresorbable group, 2 weeks of maxillomandibular fixation was also used. Evaluation of the study endpoint was done at 8 weeks postoperatively. For statistical analysis, the upper limit of the 95% confidence interval was calculated for failure to achieve the primary outcome variable and compared with the maximal clinically acceptable difference between the standard and test modalities in the failure to achieve clinical union (delta). Delta was predetermined as 2%. The other complications were tested for significance using Fisher's exact test. Of the 40 patients, 21 were in the titanium group and 19 were in the bioresorbable group, with 20 men and 1 woman in the titanium group and 18 men and 1 woman in the bioresorbable group. The mean age was 28.7 years in the titanium group and 26.6 years in the bioresorbable group. In the titanium group, the complications noted were nonunion in 0%, malocclusion in 7.7%, continued postoperative swelling in 0%, chronic pain in 2%, infection in 5.2%, an inability to chew hard food after 8 weeks in 7.7%, the need for alternative treatment in 0%, and the need for reoperation in 31%. In the bioresorbable group, the complications were nonunion in 4.17%, malocclusion in 11.1%, swelling in 8.3%, chronic pain in 37.5%, infection in 0%, an inability to chew hard food in 11.1%, the need for alternative treatment in 11.1%, and need for reoperation for plate removal in 0%. The small sample size did not allow any meaningful conclusion to be drawn from the present study in terms of the primary question of achieving union. Both groups matched in outcomes when evaluated only on a clinical basis. The avoidance of repeat surgery for plate removal is a definite advantage of using resorbable plates. However, the results are inconclusive in favor of any particular plating system.

Transoral 2.0-mm Locking Miniplate Fixation of Mandibular Fractures Plus 1 Week of Maxillomandibular Fixation: A Prospective Study

In this study, a 2.0-mm locking miniplate (LMP)/screw system was assessed in the treatment of mandibular fractures with a 1-week period of maxillomandibular fixation (MMF). Fifty mandibular fractures in 34 patients with a mean of 6.97 days of MMF were included in the study. The 2.0-mm LMPs were adapted along Champy's line of ideal osteosynthesis and secured with four 8.0-mm locking monocortical screws. All patients were followed for a minimum of 6 weeks. The incidence of soft tissue infections, nonunion, malunion, malocclusion, osteomyelitis, nerve injury, and tooth damage was prospectively assessed. Primary bone healing was achieved in 98% of cases. Three complications (6%) were observed. Two minor complications of intraoral wound dehiscence and malocclusion were noted. A fibrous nonunion requiring 3 additional weeks of MMF was noted. No evidence of malunion, osteomyelitis, plate fracture, iatrogenic nerve injuries, or dental injuries was noted. A single 2.0-mm LMP placed along Champy's line of ideal osteosynthesis with four 8-mm monocortical locking screws plus 1 week of MMF fixation is a reliable and effective treatment modality for mandibular fractures.

Transoral 2.0-mm miniplate fixation of mandibular fractures plus 2 weeks' maxillomandibular fixation: A prospective study

Purpose: We conducted a study to assess the efficacy of intraoral treatment of mandibular fractures using a 2.0-mm miniplate and 2 weeks of maxillomandibular fixation (MMF). Patients and Methods: Forty-four mandible fractures in 31 patients with a mean of 15 days of MMF were included in this study. A 2.0-mm miniplate was adapted along Champy's lines of ideal osteosynthesis and secured with four 8.0-mm monocortical screws. All patients were followed for at least 8 weeks after surgery. The incidences of bone or soft tissue infections, wound dehiscence, nonunion, malunion, malocclusion, plate fractures, and iatrogenic neurosensory deficits were prospectively evaluated. Results: Primary bone healing was achieved in 100% of cases. No soft or hard tissue infection, malocclusion, malunion, nonunion, dental injuries, plate fracture, or iatrogenic nerve injuries were observed. Two (4.52%) minor complications—intraoral wound dehiscences—were noted. Conclusions: The use of a single 2.0-mm miniplate adapted along Champy's line of ideal osteosynthesis and stabilized with 4 monocortical screws plus 2 weeks of MMF was a viable treatment modality for mandibular fractures. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:167-170, 2002

Mandibular range of motion after bilateral sagittal split ramus osteotomy with wire osteosynthesis or rigid fixation

Objectives: An analysis was conducted to compare mandibular range of motion among Class II patients treated with wire osteosynthesis or rigid internal fixation after surgical mandibular advancement. Study Design: Patients randomly received wire osteosynthesis and 8 weeks of maxillomandibular fixation (n = 49) or rigid internal fixation (n = 78). Mandibular range of motion was measured 2 weeks before surgery and 8 weeks, 6 months, and 1, 2, and 5 years after surgery. Results: Both groups showed decreased mobility in all movement dimensions that progressively recovered to near presurgical levels over the 5-year follow-up period. The difference in range of motion between treatment groups was not statistically significant. Changes in proximal and distal segment position could not explain decreased mobility. Conclusions: Similar decreases in mandibular mobility occurred with wire and rigid fixation of a bilateral sagittal split ramus osteotomy after surgery. Long-term changes were statistically, but not clinically, significant. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:274-80)

Comparison of ceftriaxone with penicillin for antibiotic prophylaxis for compound mandible fractures

Purpose. The purpose of the study was to compare the efficacy and cost of two antibiotic regimens for prophylaxis of compound mandible fractures: 1 gm/day ceftriaxone and 2 million U penicillin G every 4 hours. Design. A prospective study of 90 patients with compound mandible fractures was performed. The patients were randomized to the two antibiotic regimens. The surgical procedures were performed by oral/maxillofacial surgery residents at a large urban training center. Standard treatment consisted of open reduction with either bone plates or wires, with all patients receiving 6 weeks of maxillomandibular fixation. The patients were monitored at 2-week intervals for 8 weeks by two of the authors, who were blinded to which antibiotic regimen the patient was assigned. Results. Two patients in each group had postoperative infections within the first 2 weeks of treatment. The infections resolved with local wound care, removal of internal fixation devices, and oral antibiotics. After resolution of the infection each patient had a malunion, which was managed without additional complications. The cost difference between the two treatment regimens was approximately $350 per day. Conclusion. Ceftriaxone was noted to be an efficacious and cost-effective treatment alternative to penicillin G for compound mandible fracture antibiotic prophylaxis.

Rigid fixation of the modified mandibular condylotomy

The modified mandibular condylotomy is a procedure that has been used to treat various disorders of the temporomandibular joint. The procedure, as described by Hall, Nickerson, and McKenna, resulted in a success rate of 92% on a group of patients with reducing discs.’ The low morbidity of the operation adds to its attractiveness for the treatment of a painful temporomandibular joint. The procedure has its disadvantages, as well, the foremost being the use of maxillomandibular fixation (MMF). Although some clinicians report using as little as 10 days of MMF, the thought of having one’s jaws “wired shut” frightens most people. There are also some patients in whom MMF is contraindicated. Through clinical and radiographic observations we have noticed that the position of the proximal segment obtained after 3 to 4 weeks of MMF is similar, if not identical, to that which is obtained intraoperatively. The idea of rigidly fixing the segments was thus conceived.

Stability of sagittal split osteotomies: A comparison of three stabilization techniques

The objective of this study was to retrospectively evaluate stability of mandibular advancement after bilateral sagittal split osteotomies were performed. Three different fixation and immobilization protocols were examined. Thirty-three patients were evaluated with preoperative, immediate postoperative, and long-term (mean, 13 months) lateral cephalometric radiographs. The patients were divided into three groups: group 1 ( n = 10) had nonrigid internal fixation and 6 weeks of maxillomandibular fixation, group 2 ( n = 12) had rigid internal fixation and immediate postoperative function, and group 3 ( n = 11) had rigid internal fixation with maxillomandibular fixation for a mean of 14 days. Group 3 had the least amount of sagittal and vertical relapse. Differences in sagittal relapse were statistically significant between groups 1 and 3. Group 2 demonstrated greater sagittal relapse than did group 3, although the result was not statistically significant. This study suggests that the use of rigid internal fixation with a period of maxillomandibular fixation appears to be more stable than nonrigid internal fixation with maxillomandibular fixation or rigid internal fixation without maxillomandibular fixation.

Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures: A clinical study of 52 cases

To compare open versus closed reduction of unilaterally dislocated low subcondylar fractures in adults, 101 consecutive dentulous patients were treated either by closed reduction with a median of 4 weeks of maxillomandibular fixation, or with a median of 6 weeks of maxillomandibular fixation after surgical repositioning and transosseous wiring of the dislocated condylar fragment. No selection of patients was done for either treatment. Fifty-two patients were seen at a median of 2 years postoperatively. Complications such as malocclusion, mandibular asymmetry, impaired masticatory function, and pain located to the affected joint or masticatory muscles were seen significantly more frequent in patients treated with closed reduction compared with those treated surgically ( P = .005). Neither the degree of dislocation of the proximal fragment, concomitant mandibular fractures, nor the absence of posterior occlusal support seemed to influence the results.

Superior repositioning of the maxilla combined with mandibular advancement: Mandibular RIF improves stability

Postsurgical changes in 24 patients who had rigid internal fixation (RIF) of the mandible with screws after combined superior repositioning of the maxilla and mandibular advancement were compared with 53 patients who underwent the same surgery but who had intraosseous wire fixation, skeletal suspension wires, and 8 weeks of maxillomandibular fixation (MMF). During the first 8 weeks after surgery, the mean posterior relapse of the mandible was greater in the MMF group than in the RIF group (for example, -1.1 mm versus 0.15 mm at B point), and the percentage of patients with clinically significant vertical and horizontal changes was greater in the MMF group. By 1 year, there had been slight additional mean relapse in the MMF group (-1.5 mm net relapse at B point, with 42% of the patients showing 2 mm or more relapse). In the RIF group, the mandible was more likely to be repositioned forward than posteriorly (net mean change at B point, 0.7 mm forward; 33% had 2 mm or more forward movement). In the RIF group, all but one of the patients (96%) were judged to have an excellent clinical result; in the MMF group, the corresponding figure was 60%.

Osseous healing of the sagittal ramus osteotomy: A histologic comparison of rigid and nonrigid fixation in Macaca mulatta

Twenty-three adult female rhesus monkeys underwent advancement of the mandible by the sagittal split ramus osteotomy. Twelve had the proximal and distal segments wired together and underwent 6 weeks of maxillomandibular fixation (MMF). Eleven animals had bicortical bone screws placed between the segments and no postsurgical MMF. The animals were killed at 6 and 12 weeks and the osteotomy sites were prepared for histologic examination. Overall, the results showed that the two groups of animals underwent markedly different patterns of osseous healing. The osteotomy sites in the MMF animals were filled with callus, which then formed bone. In contrast, no callus was found in the majority of the rigid fixation osteotomy sites; direct bony deposition was found instead. The results of this investigation show that, like long bones, the sagittal osteotomy can heal by direct or indirect means depending on the rigidity of the fixation.

Fixation of mandibular fractures: A comparative analysis of rigid internal fixation and standard fixation techniques

This study used a prospective design to compare standard therapy (closed or open reduction with 4 weeks of maxillomandibular fixation) to rigid internal fixation (RIF) for the treatment of mandibular fractures. Ninety-two patients with 143 fractures were evaluated and treated. There was no statistically significant difference in the treatment results between the two groups, despite a bias in the distribution of study variables that favored the standard therapy.