Compare the Efficacy of Open Reduction and Internal Fixation of Mandibular Fractures With and Without Use of Intra-Operative Inter-Maxillary Fixation

Bhushan, Kritant; Unakalkar, Sumanth; Sahu, Rajnish; Sharma, Mohit

doi:10.1007/s12070-021-02830-3

Cited by 2 publications

(11 citation statements)

References 16 publications

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“…The reported rates range from 3% to 6% in the manual MMF group and from 7% to 12% in the rigid MMF group. [6][7][8]15,16,18 Singh et al 8 reported a significantly lower number of infective events in the manual group (OR, 0.38; 95% CI, 0.15-0.97). In agreement with previous reports, the present study found a higher incidence of infective complications in the rigid MMF group (5.8% soft tissue infections and 1% bone infections) compared to the manual MMF group (3.6% soft tissue infections and no bone infections), but without statistical significance.…”

Section: Discussionmentioning

confidence: 97%

“…8,[13][14][15][16] There is no consensus regarding the indications for manual MMF because most of the previous studies have focused on certain fracture patterns or have included fractures that were treated conservatively. 7,12,[15][16][17] The present study only included mandibular fractures treated with ORIF, and excluded those managed conservatively. In these latter cases, both intra-and postoperative MMF were necessary for bone healing.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] MMF is usually performed using arch bars, self-tapping and self-drilling screws (STSDSs), or eyelet wires. [6][7][8][9] The MMF obtained by such wire-based methods, defined as 'rigid', is a reliable technique to maintain a stable alignment of the bone fragments. However, it has several disadvantages, including the risk of needle-stick injuries and infection transmission, periodontal and root damage, hardware loosening or ingestion.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8]10 Furthermore, rigid MMF is time-consuming and significantly prolongs the operating time. 7,8,11,12 An increasing number of studies have reported the use of manual intraoperative MMF, without the need for wire-based techniques, for certain mandibular fractures since the 1990s. 6,7,9,[11][12][13][14][15][16][17][18] However, a recent systematic review and meta-analysis by Singh et al 8 on isolated single or double mandibular fractures suggested that the current evidence in favour of manual MMF is based on a few retrospective and prospective, single-centre studies, with a high risk of bias.…”

Section: Introductionmentioning

confidence: 99%

“…However, it has several disadvantages, including the risk of needle‐stick injuries and infection transmission, periodontal and root damage, hardware loosening or ingestion 6–8,10 . Furthermore, rigid MMF is time‐consuming and significantly prolongs the operating time 7,8,11,12 …”

Section: Introductionmentioning

confidence: 99%

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

Sobrero

Roccia

Vilaplana

et al. 2023

Dental Traumatology

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PurposeIntraoperative stabilisation of bony fragments with maxillo‐mandibular fixation (MMF) is an essential step in the surgical treatment of mandibular fractures that are treated with open reduction and internal fixation (ORIF). The MMF can be performed with or without wire‐based methods, rigid or manual MMF, respectively. The aim of this study was to compare the use of manual versus rigid MMF, in terms of occlusal outcomes and infective complications.Materials and MethodsThis multi‐centric prospective study involved 12 European maxillofacial centres and included adult patients (age ≥16 years) with mandibular fractures treated with ORIF. The following data were collected: age, gender, pre‐trauma dental status (dentate or partially dentate), cause of injury, fracture site, associated facial fractures, surgical approach, modality of intraoperative MMF (manual or rigid), outcome (minor/major malocclusions and infective complications) and revision surgeries. The main outcome was malocclusion at 6 weeks after surgery.ResultsBetween May 1, 2021 and April 30, 2022, 319 patients—257 males and 62 females (median age, 28 years)—with mandibular fractures (185 single, 116 double and 18 triple fractures) were hospitalised and treated with ORIF. Intraoperative MMF was performed manually on 112 (35%) patients and with rigid MMF on 207 (65%) patients. The study variables did not differ significantly between the two groups, except for age. Minor occlusion disturbances were observed in 4 (3.6%) patients in the manual MMF group and in 10 (4.8%) patients in the rigid MMF group (p > .05). In the rigid MMF group, only one case of major malocclusion required a revision surgery. Infective complications involved 3.6% and 5.8% of patients in the manual and rigid MMF group, respectively (p > .05).ConclusionIntraoperative MMF was performed manually in nearly one third of the patients, with wide variability among the centres and no difference observed in terms of number, site and displacement of fractures. No significant difference was found in terms of postoperative malocclusion among patients treated with manual or rigid MMF. This suggests that both techniques were equally effective in providing intraoperative MMF.

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