Clinical and Radiological Analysis of Arch Bars Over-Retained for 14 years Post Maxillo-Mandibular Fixation

Maxillo-mandibular fixation (MMF) is common technique used in mandibular fractures to stabilize the fragments and maintain the patient in normal dental occlusion during the healing process. Arch bars with elastics are one of the most frequently used methods of MMF and are temporary, and designed to be removed after the healing process is completed. There is controversy as to what impact the hardware has on dental hygiene and oral health. No reports of long-term retention of the hardware exist. This report details the case of arch bars retained for 14 years. The patient underwent MMF and internal fixation at age 16 for a complex mandibular fracture and failed to follow-up for timely removal of the arch bars due to loss of insurance. He presented at age 30 with dental pain and returned to the treating center for removal. He was in normal occlusion, but general indices of dental and periodontal health were extremely poor with multiple non-restorable teeth despite reporting good oral hygiene in the intervening period. A decline in overall dental health was evident at 1 year following removal of arch bars. Due to the presence of smooth surface dental caries, it was concluded that the presence of the arch-bars had exacerbated already poor oral hygiene and contributed to the extensive dental pathology seen. This case highlights the need for timely follow-up and hardware removal. Understanding each patient’s individual social and financial circumstances is essential to this process and a formalized office recall process may have prevented this complication.

New method for intraoperatory occlusal restauration in mandibular angle fractures treatment using two modified reduction forcepssing two modified reduction forceps

The treatment of mandibular angle fractures presents several possibilities for fixation methods and surgical approaches which can be intraoral or can be accessed through the skin. An important point would be intraoperative occlusal restoration. We present a method that replaces the traditional form using an erich bar and which, in our view, is a fast and effective method for intraoperative occlusal restoration.Descriptors: Inter Maxillary Fixation (IMF); Occlusion; Arch Bar Fixation.ReferencesJohnson AW. Dental occlusion ties: A rapid, safe, and non-invasive maxillo-mandibular fixation technology. Laryngoscope Investig Otolaryngol. 2017;2(4):178-83.Abbasi AJ, Parvin M. New method of arch bar fixation. Br J Oral Maxillofac Surg. 2017;55(6):631-32.Shinohara EH, Mitsuda ST, Miyagusko JM, Horikawa FK. Mandibular fracture reduction without intraoperative intermaxillary fixation: a technique using two modified reduction forceps. J Contemp Dent Pract. 2006;7(1):150-56.

Penatalaksanaan fraktur simfisis mandibula dengan dua perpendicular mini-plates

Latar belakang: Fraktur mandibula merupakan salah satu fraktur daerah wajah yang paling sering terjadi. Penatalaksanaan kasus fraktur mandibula membutuhkan pemahaman secara komperehensif meliputi faktor anatomi, biomekanik, dan oklusi. Ketiga faktor tersebut bertujuan untuk mengembalikan fungsi mandibula yang sangat bergantung pada posisi anatomis fragmen tulang, dengan morbiditas seminimal mungkin. Plate and screw telah digunakan selama beberapa dekade terakhir untuk memfasilitasi stabilitas fragmen tulang di daerah maksilofasial, dan sampai saat ini merupakan teknik yang paling sering digunakan. Tujuan: Memahami prinsip penatalaksanaan kasus fraktur simfisis mandibula menggunakan 2 perpendicular mini-plates. Kasus: Dilaporkan laki-laki, berusia 24 tahun dengan fraktur multipel wajah (fraktur komplit simfisis mandibula, fraktur sagital palatum, dan fraktur rima orbita inferior) akibat kecelakaan lalu lintas. Metode: Pencarian literatur dilakukan melalui Cochrane, Pubmed, ClinicalKey, dan Wiley dalam kurun waktu 5 tahun terakhir. Berdasarkan kriteria inklusi dan eksklusi, didapatkan satu artikel yang telah dilakukan critical appraisal. Hasil: Dari 25 pasien dengan fraktur mandibula, semua pasien dilakukan tindakan open reduction diikuti dengan penggunakan fiksasi 2 mini-plates. Penatalaksanaan yang dilakukan untuk fraktur mandibula pada kasus ini adalah open reduction internal fixation (ORIF) menggunakan 2 perpendicular mini-plates, dan pemasangan intermaxillary fixation (IMF), serta maxillo-mandibular fixation (MMF) untuk menjaga stabilitas tulang, guna mendukung proses osifikasi pada fraktur palatum. Kesimpulan: Penggunaan dua buah plate and screw pada simfisis mandibula, dengan kombinasi MMF dan IMF selama 4 minggu berhasil memberikan hasil oklusi yang baik dengan komplikasi seminimal mungkin. Kata kunci: Fraktur mandibula, ORIF, MMF, IMF, perpendicular mini-plates ABSTRACT Background: Mandible fracture is one of the most common fractures in facial region. Management of mandible fractures a comprehensive knowledge about anatomical, biomechanic and occlusion factors. These factors are essential to normalize the mandible function with minimal morbidity, and it very much depends on its bone fragments anatomical position. Plate and screw have been used for decades to facilitate the stability of bone fragments in maxillofacial region, and nowadays is still frequently used technique. Objective: Understanding the principal management of mandibular symphysis fracture using two perpendicular mini-plates. Case: A 24 year-old male presented with multiple facial fractures due to traffic accident (mandibular symphysis complete fracture, sagital palatum fracture and inferior orbital rim fracture). Method: Literature study was conducted through Cochrane, Pubmed, ClinicalKey, and Wiley within last 5 years. An article has been retrieved based on the critical appraisal that was subjected to exclusion and inclusion criteria. Results: Among 25 patients with mandibular fractures, surgical procedures were performed through open reduction and internal fixation with the use of 2 mini-plates. Open reduction internal fixation (ORIF) using 2 perpendicular mini-plates was performed, followed by installation of intermaxillary fixation (IMF), and maxillo-mandibular fixation (MMF), to maintain bones stability that was needed to support ossification process of sagital palatal fracture. Conclusion: Management of mandibular fracture using two perpendicular mini-plates upon mandibular symphysis, by combining MMF and IMF for 4 weeks, was successful to obtain a good occlusion with a minimal complication. Keywords: Mandible fractures, ORIF, MMF, IMF, 2 perpendicular mini-plates