Are Arch Bars Necessary for Maxillomandibular Fixation? - a Paradigm Shift
Open treatment of mandible fracture often requires intraoperative maxillomandibular fixation (MMF). Traditionally, MMF with arch bars has been the main stay of facial fracture management. However MMF with arch bars has significant disadvantages, including time of application, additional procedures to remove them, risk of periodontal disease, risk of dental caries, and the risk of infectious disease transmission. The purpose of this study is to compare the outcomes and cost effectiveness of MMF with embrasure wife fixation versus with arch bars.
This is a retrospective case review of adult patients treated for mandible fractures between July 2012 and December 2012. Only patients with open reduction and internal fixation were included in the study. Patients were divided into embrasure wire group and arch bar group. Further more they were stratified into subgroups based on the complexity & the location of the fracture. The total surgical time was recorded for each patient and compared between the groups. Surgical complications including malocclusion, infection, non-union, fibrous union, and hardware failure were analyzed. Only patients with complete medical records were included in the study.
A total of 46 patients were included in the study. There were 42 males and 4 females. The average age of the patients was 27.15 years. Caucasian whites formed 58.7% of the cohort and African American formed the rest. The major etiology of their injuries was assault (65.2%), followed by fall (18%). Embrasure wires were used in 22 patients and arch bars in 24. The average surgical time with embrasure wire MMF was much less than the time with Arch bars. Embrasure wire fixation had slightly better postoperative outcomes between the two techniques. Hardware failure was equally distributed with about 19% in each group. Malocclusion was noted to be higher in the arch bar group (8.33%) compared to the embrasure group (4.54%). One patient in the arch bar group had undergone a reoperation. The rate of infection was slightly higher (16.6% vs 13.6%) in the arch bar group. The cost of embrasure wire fixation was significantly less than the arch bars.
Maxillomandibular fixation with embrasure wires is efficient, effective, and takes significantly less time than with arch bars. Embrasure wire technique is significantly cost effective and eliminates the need for another surgical procedure to remove arch bars. When compared to MMF with arch bars, embrasure wire fixation is at least $1000 less expensive per patient. This does not include the thousands of dollars saved in operating room time. Also, this technique eliminates the risk of dental caries, periodontal disease, and risk of infectious disease transmission. Data from a larger patient cohort is being analyzed for outcomes.
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2. Bell RB, Wilson DM. Is the use of arch bars or interdental wire fixation necessary for successful outcomes in the open reduction and internal fixation of mandibular angle fractures? J Oral Maxillofac Surg. 2008 Oct;66(10):2116-22.