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

Abstract

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.

Predictive factors for maxillofacial fractures, sedentary behavior, and dental trauma literacy

“…23,25 In this Issue, Sobrero et al conducted a prospective multicentre study comparing the occlusal outcomes and infective complications between manual and rigid MMF in the surgical treatment of mandibular fractures using plate osteosynthesis. 26 Twelve European centers prospectively collected data on patients hospitalized for mandibular fractures and treated with ORIF. Through this study, the authors present important considerations for clinicians to evaluate when deciding between rigid and manual MMF in their patients with mandibular fractures.…”