Open Reduction and Internal Fixation of Mandibular Fracture without Rigid Maxillomandibular Fixation

Abstract

Introduction The ability to treat fracture with open reduction and internal fixation (OR/IF) has dramatically revolutionized the approach to mandible fracture. With OR/IF, the postoperative role of rigid maxillomandibular fixation (MMF) has declined, but it is used to maintain proper occlusion until internal fixation of the fracture is achieved. Objective To assess intraoperative manual MMF during OR/IF of selected cases of mandibular fractures. Methods This prospective study was conducted on 80 patients with isolated mandibular fractures managed by OR/IF using two titanium miniplates. The patients were classified into two groups: a control group (40 patients) treated by OR/IF after intraoperative rigid MMF followed by immediate MMF removal, and a study group (40 patients) treated by rigid MMF, which was replaced by temporary intraoperative manual MMF (3MF) until plate fixation. Results There were no significant differences of the postoperative complication and dental occlusion, although a highly significant reduction of operative time was achieved in the 3MF group. Patient who received the 3MF technique had statistically significantly better average intrinsic vertical mouth opening in the early postoperative period (1 week after surgery), and normal mouth opening could be achieved in all cases in both groups 8 weeks after surgery. Conclusions Intraoperative rigid MMF is not mandatory and can be replaced in selected cases of fracture mandible by manual maintenance of proper dental occlusion until hardware fixation, gaining the advantages of shorter operative time and less risk of blood-transmitted diseases to the surgical team and the patient in addition to the benefits of immediate postoperative mandible mobilization.

Manual versus rigid intraoperative maxillo‐mandibular fixation in the surgical management of mandibular fractures: A European prospective analysis

“…Although few European centres were found to use manual MMF routinely in the present study (Table 6), the percentage was significantly greater than that reported by Gear et al 20 The increased use of manual MMF may be justified by the reduced operator and patient risks, including needle-stick injuries, communicable disease transmission, and mucosal and dental injuries. 7,12,18 It is also more economical because it reduces the operative and hospitalisation times, and the cost related to hardware manufacturing and the personnel needed to apply and remove it. 8,13,14,16 However, most authors agree on the need of an experienced assistant to perform manual MMF.…”

Many Moving Pieces: Virtual Preoperative Surgical Planning for Traumatic Occlusal Splints

“…[2][3][4] In patients with complex facial fractures involving the maxillomandibular unit, the fundamental objective should be to first establish the premorbid occlusion. [7][8][9] Once this has been established, the framework for the remainder of the surgery can be based around the reduced maxillomandibular region. 1 The reasons for this are two-fold.…”

Changing Trends in the Treatment of Mandibular Fracture

“…The purposes of the treatment of mandibular fractures are to restore the pre-trauma dental occlusion and normal mouth opening and to reduce the displaced fracture. 4 …”

“…These factors opened the door for recent studies searching for simpler, faster, easier and at the same time effective OR/IF of the fractured mandible. 4 …”

“…After a prospective comparative study, El-Anwar et al 4 found that manual MMF (3MF) during the OR/IF of selected cases of mandibular fractures could be successfully performed, allowing for a more rapid and less complex procedure limited to the mandible. In addition to the gained benefits of immediate postoperative mandible mobilization, 3MF provided significantly shorter operative times ( p < 0001), less risk of blood-transmitted diseases to the surgical team and the patient, and significantly better early mouth opening ( p = 0.0015).…”