Eur J Plast Surg (1998) 21:215±216
IDEAS AND INNOVATIONS
lu ´ A. Keser ´ Ö. SËensöz
Maxillomandibular fixation with a combination of arch bars
Received: 14 March 1997 / Accepted: 10 September 1997
) ´ A. Keser ´ Ö. SËensöz
Department of Plastic and Reconstructive Surgery,
Ankara Numune Hospital,Ankara, Turkey
Kenedi Cad. 61/8, TR-06660 Kavaklidere, Ankara, Turkey
Abstract A method is presented for the treatment of
mandibular fractures in which maxillomandibular fixation
was achieved with a combination of an arch bar and
screws which was not dependent on the condition of the
patient's teeth for the treatment of the mandible fracture.
The technique and a representative case is discussed.
Key words Mandible fracture ´ Maxillomandibular
fixation ´ Arch bar ´ Screw
Maxillomandibular fixation with arch bars and elastics is
an effective and simple method for the treatment of un-
complicated mandibular fractures. However, it cannot
be used in patients whose dental condition will not allow
an arch bar to be applied.
A new maxillomandibular fixation technique is pre-
sented for the treatment of mandible fractures which does
not depend on the condition of the teeth for treatment.
The procedure can be carried out under local or general anesthesia.
After the infiltration of the vasoconstrictor solution, small transverse
incisions are performed on mucosa away from the root apices. Gen-
erally, four or five incisions are enough for each jaw. The bone is
now exposed with a periosteal elevator and the screws are inserted
without perforating the palatal and lingual mucosa. In the mandible
the neurovascular bundles must be protected.
When placing screws, 3 mm of the screw's shaft should be left
protruding. An arch bar is placed on the screw and stabilized with
stainless steel wires. Elastics are attached to the arch bars in order
to obtain the desired occlusion.
After an adequate period of immobilization, the screws and arch
bar are removed under local anesthesia.
A 24-year-old male presented with an open symphysis fracture and a
right condylar fracture. He had only incisors and canines with an
aesthetic porcelain prosthesis on the upper jaw. The symphysis frac-
ture was reduced and miniplates and screws were applied under gen-
eral anesthesia. Closed reduction was considered for nondisplaced
Fig. 1 On the maxilla, the arch bar is placed over the screws and
stabilized with stainless steel wires
Fig. 2 A postoperative panoramic radiograph showing screws and
an arch bar on the upper jaw to treat a right condylar fracture