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This narrative review evaluates the literature on the management of mandibular condyle fractures in growing patients. It aims to illustrate some fundamental biological principles and to offer a series of considerations applicable to clinical practice. The discussion is based on 116 papers published in PubMed and two relevant textbooks. Condylar fractures may be overlooked, especially in pre-scholar children, where compliance is usually reduced. However, these injuries can have disabling sequelae such as ankyloses, facial deformities, malocclusion, and chronic pain in some patients if not diagnosed and managed correctly. Due to their significance, mandibular condyle fractures in children are a subject of considerable clinical interest. As of today, there is consensus about their treatment. Four management options are available: expectative (analgesia, soft food and follow-up), functional protocols (guiding elastics, orthodontic appliances and exercises), maxillomandibular fixation (MMF), and open reduction and internal fixation (ORIF). Nondisplaced and minimally displaced fractures should be treated expectantly; severely displaced non-comminuted fractures can be safely operated on if the expertise is available, even in patients with deciduous dentition. Moderately displaced fractures can be managed with functional protocols or operatively, depending on the background and know-how of the specialist. Functional protocols can achieve good outcomes, especially in patients with deciduous dentition. MMF should be foregone in children due to its many drawbacks. [ABSTRACT FROM AUTHOR]

Introduction: Either in conservative or in surgical management of maxillo‐mandibular fractures, intermaxillary fixation (IMF) provides stable occlusion, while offering reduction in the fractured segments. Various techniques have been used for achieving IMF, among which Erich arch bar is the most conventional and routinely used technique. However, it poses a risk of percutaneous injury to the surgical team with every wire used in the technique, causes trauma to the periodontium of the teeth secured by wires and it is not very comfortable for the patient. The few IMF techniques that are recommended without wire require special armamentarium that are not universally available. Materials and Methods: Our novel IMF technique employing multiple looping of orthodontic E chains around IMF screws can provide adequate reduction and stabilization of the fractured segments with good occlusion before plating of the maxillo‐mandibular fractures. It can also be utilized for extended periods for closed reduction or postoperatively for guiding the occlusion. Results: As seen in our clinical experience using this novel technique, there is no risk of percutaneous injury to the surgical team. It provides stable occlusion, optimal reduction in the fractured segments and is accepted well by patients as no wires are used. Conclusion: This novel technique can be used in all patients who require IMF and is particularly useful in patients with periodontally compromised teeth or in those who are partially edentulous where conventional arch bar fixation cannot be performed. This technique will considerably reduce the operative time and aid in better patient compliance. [ABSTRACT FROM AUTHOR]

This review examines the prevailing modalities for fractures of the anterior mandible, which represent a significant proportion of the maxillofacial injuries commonly treated by oral and maxillofacial surgeons. The article traces the historical shift from conservative techniques to the dominant management strategies of open reduction and fixation. Encompassing a range of studies, the review, in accordance with PRISMA 2020 recommendations, meticulously examines various fixation methods, assessing their efficacy in achieving stability of fracture, early healing, and mobilisation. The comparison of these methods highlights their unique advantages and limitations, and demonstrates the need for more nuanced and precise approaches. The review emphasises evidence-based methodology in the management of anterior mandibular fractures (AMF), highlighting the benefits offered by innovative techniques such as 3D miniplates. It also acknowledges the advantages provided by older fixation devices such as lag screws. The importance of postoperative outcomes and the need for tailored treatment strategies are recognised, considering the complex nature of these fractures. [ABSTRACT FROM AUTHOR]

Introduction: Le Fort I fractures represent a significant proportion of craniofacial trauma, often occurring alongside other injuries to the craniomaxillofacial region. Management options include open reduction and internal fixation (ORIF) or skeletal suspension, each with its limitations and considerations. Material and Methods: This technical note presents a novel technique for managing isolated Le Fort I fractures using intermaxillary fixation (IMF) screws, offering a minimally invasive alternative to ORIF. The technique involves the strategic placement of IMF screws in the stable zygomatic bone, coupled with arch bar fixation and wire manipulation for maxillary fragment reduction. Results: This approach is cost-effective, can be performed under local anesthesia, and provides stability without the need for prolonged maxillomandibular fixation (MMF). Conclusion: The simplicity and efficacy of this technique make it suitable for emergency settings and cases where traditional approaches may not be feasible. However, this technique is only feasible in isolated Le Fort I fractures and is contraindicated in comminuted Le Fort I fractures and in edentulous patients with upper jaw involvement. [ABSTRACT FROM AUTHOR]

Background: Over the years, the epidemiology of maxillofacial fractures keeps changing and new trends in etiology, pattern of presentation and management are constantly evolving. This, therefore, necessitates a constant appraisal of these fractures injuries in order to keep abreast with recent developments and changing pattern of their management. The aim of this study was to determine the frequency, etiology, patterns and different treatment modalities for maxillofacial fractures in patients treated at Lahore Medical and Dental College/Ghurki Trust Teaching Hospital (LMDC/GTTH). Methods: This cross sectional descriptive study was carried out at Lahore Medical and Dental College/Ghurki Trust Teaching Hospital (LMDC/GTTH) from February 2014 to October 2017.A total of 161 patients having maxillofacial fractures were included in the current study. Data on patients, including age, gender, cause of injury, fracture site, pattern and treatment modalities were collected and analyzed using SPSS version 20. Results: The age range was 3 to 62 (mean/SD, 26.42±11.24) with peak frequency occurring in age group 21-30 years. The male to female ratio was 5.2:1. The most common cause of maxillofacial fractures was road traffic accident (RTA) in 134 (83.23%) of patients, followed by in fall 12 (07.46%) and assault in 09 (05.59%) patients. The most frequent bone fractured was the mandible, which accounted for 117 (72.67%) cases and parasymphysis (43.22%) was the most frequent site affected, followed by 67 (41.61%) cases of zygomatic complex fracture and 56 (34.78%) cases of maxillary fractures. Open reduction and internal fixation (ORIF/ORIF with IMF) was performed in 127(78.88%) of patients while closed reduction and indirect fixation (IMF with eyelet wiring/arch bar elastics & splint fixation) was done in 34 (21.12%) of patients. Conclusion: As evidenced by the present study, majority of fractures were caused by RTA in 21-30 age group with male predominance. Mandible was the predominant fractured bone followed by the zygomatic complex area. ORIF was treatment of choice in the current study. According to present study, it seems reasonable to recommend that road traffic legislation enforcement and continuous public education towards the use of restraining devices and helmets should be encouraged by relevant authorities.

Objective: This finite element analysis (FEA) aimed to assess the stress distribution in the mandible and fixation system with various directions of the intermaxillary fixation (IMF) using mini‐implants (MIs) and elastics following mandibular advancement with a bilateral sagittal split ramus osteotomy (BSSRO). Materials and Methods: A total of nine mandibular advancement models were set according to the position of the MIs (1.6 mm in diameter, 8 mm in length) and direction of the IMF elastics (1/4 inch, 5 oz). Major and minor principal stresses in the cortical and cancellous bones, von Mises stresses in the fixation system (miniplate and monocortical screws), and bending angles of the miniplate were analysed. Results: Compressive and tensile stress distributions in the mandible and von Mises stress distributions in the fixation system were greater in models with a Class III IMF elastic direction and a higher IMF elastic force than in models with a Class II IMF elastic direction and a lower IMF elastic force. The bending angle of the miniplate was negligible. Conclusions: Stress distributions in the bone and fixation system varied depending on the direction, amount of force, and position of IMF elastics and MIs. Conclusively, IMF elastics in the Class II direction with minimal load in the area close to the osteotomy site should be recommended. [ABSTRACT FROM AUTHOR]

Intermaxillary fixation (IMF) using the arch bar has been the standard technique for a long time in the management of mandibular fracture. However, tooth borne IMF may cause several complications, hence intermaxillary fixation with screws has been introduced and adopted to use. This investigation compared the treatment outcomes and complications between the traditional IMF and modified intermaxillary fixation with screws technique. This review was done according to PRISMA Guidelines. We searched through PubMed, Science Direct, Scopus, EMBASE, and Cochrane. The keywords used were of "intermaxillary fixation", "arch bar", "screw", "maxillofacial fracture", "outcome", "occlusion". Inclusion criteria encompassed clinical trials, observational studies, and retrospective analyses comparing treatment outcomes between tooth-borne and bone-borne IMF devices. 1,391 studies were identified, after eliminating process of the duplicates and irrelevant studies, the remaining 13 studies were included and assessed for qualitative analysis. The treatment outcome indicators were divided into group; intraoperative, postoperative, and complications. Both types of IMF are significantly beneficial, however, each type has their own challenges. In choosing the type of device, surgeon's preference, and experience, also a thorough case-by-case selection are important in achieving occlusal goals in treating maxillofacial fractures. [ABSTRACT FROM AUTHOR]

Introduction In this study efficacy of new method for arch bar fixation was compared with conventional technique in facial bone fracture management. Material and Methods 20 Patients with facial bone fracture reported to the Department of Oral and maxillofacial Surgery requiring open reduction were included in the study. The clinical parameters that were evaluated are Oral hygiene and Gingival index. Results The mean OHI-S score in new technique and conventional technique in 1st week was 1.36 ± 1.19 and 0.81±0.53 respectively. In 2nd week the mean OHI-S score in new technique was 1.22 ±0.77 and in conventional technique the mean OHI-S score was 1.39 ± 1.51.In the 3rd week the mean OHI-S scores of new technique and conventional technique were 1.8 ±0.55 and 1.6 ±1.73 respectively. The mean GI score in new technique and conventional technique in 1st week was 0.69 ± 0.5 and 0.38 ± 0.3 respectively. In 2nd week the mean GI score in new technique was 0.63 ±0.4 and in conventional technique the mean GI score was 0.36 ± 0.3. In the 3rd week the mean GI scores of new technique and conventional technique were 0.65 ±0.3 and 0.35 ± 0.3 respectively. Conclusion In a whole we can conclude from this clinical study that both the techniques were equally effective in terms of Oral hygiene, gingival health and stability. [ABSTRACT FROM AUTHOR]

Objective Although mandibular condylar fractures represent one of the most frequent types of fractures in the mandible, their treatment remains controversial. This study aimed to determine the safety of treatment method, reduce postoperative complications, and describe our clinical experience. Material and Method Fifty-three patients with subcondylar mandibular fractures were included. The patients were treated with closed reduction (CR) or open reduction and internal fixation (ORIF). Arch bar or intermaxillary screws, and rubber were used for intermaxillary fixation (IMF) in all patients. Statistical analysis was subsequently performed. Results A total of 37 male patients and 16 female patients were included in this study. Falls were the most common cause of mandibular fractures in the study (n=23; 43.3%). Postoperative complications included malocclusion, temporomandibular dysfunction (mouth opening less than 30 mm), facial nerve neuropathy, and infection. There was no statistically significant difference between the CR and ORIF groups in the postoperative complication of malocclusion. All patients with malocclusion (n=8) had concomitant fractures (n=23). There was a statistically significant difference between the subgroups (group with concomitant fracture and group without concomitant fracture) in terms of postoperative malocclusion complications. A mean duration of 21 days was also always associated with temporomandibular dysfunction. Conclusion This study demonstrated the need for balancing the pros and cons in determining the proper treatment choice. ORIF has several advantages; however, it can be accompanied by postoperative complications. The duration of IMF can lead to functional disorders, and patients should cooperate with consultants in the treatment decision. [ABSTRACT FROM AUTHOR]

The Sub-condylar region is a common place for mandible fractures and these fractures can be managed by open reduction and internal fixation techniques, or only inter-maxillary fixations. The aim was to reveal the effects of healing of these fractures on clinical and radiologic findings. This is a clinical study including 15 patients. All patients had unilateral sub-condylar fractures and patients who had bilateral sub-condylar fractures, intra-articular fractures, or displaced mandible fractures that were located on another subpart were excluded. Clinical assessments include occlusion, maximum mouth opening at an interincisal distance, deviation of the mandible with mouth opening, and general oral and health assessment index. Radiologic assessments include the heights of the condyles and rami + condyles, and the distances between the mandible anguli and cranial base. Statistical tests have been performed. The patients' ages ranged between 9 and 70 years (mean:28.1±15.4). Follow-up period ranged between 6 and 74 months (mean: 28.3±27.2). 13 patients had normal occlusions. The mean maximum mouth opening was 4.3±0.69 centimeters. 11 patients had a mean mandibular deviation of 0.26±0.27 centimeters with mouth opening. Clinical effects of the fracture and healing period can be accepted as quite satisfying in both clinical and radiologic means with either treatment options including open reduction internal fixations and IMF/Arch-Bar-only techniques. Long-term results of sub-condylar region fractures are quite acceptable with a high level of quality of life. [Med-Science 2022; 11(4.000): 1702-10]

Anaesthesia for orthognathic surgery requires thorough preoperative planning and multidisciplinary involvement. Patients are generally young and healthy, though there is an increasing trend in treatment of patients with obstructive sleep apnoea syndrome, associated with increased premorbid disease burden. Principles of perioperative management include close cooperation between surgeon and anaesthetist, a multifaceted approach to minimizing blood loss, multimodal analgesia, anti-emesis prophylaxis, and a carefully planned, communicated and executed airway management strategy. Nasotracheal intubation is routinely performed to maximize surgical access and permit intraoperative dental occlusion, though retromolar or submental intubation may occasionally be indicated. Patients with temporomandibular joint pathology or some congenital syndromes may necessitate awake airway management techniques. A clear strategy for tracheal extubation should be established in advance, including a well-defined re-intubation plan, especially for patients with intermaxillary fixation devices. Patients should be managed in an appropriately equipped and staffed postoperative care facility. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the feasibility, effectiveness, and reliability of using conventional miniplates to provide stable maxillomandibular fixation (MMF) for the management of condylar fracture(s) in complete/partial edentulous mandible. Eleven displaced condylar fractures (37.5% bilateral) in eight completely/partially edentulous adult males (mean age: 43.37) were immobilized with 2–3 conventional miniplates (across two jaws) and followed for three months. All cases showed stable mandibular immobilization during the MMF period. MMF-miniplates were removed after six weeks under local anesthesia. Satisfactory mouth opening was observed after MMF-miniplate removal. No cases of MMF-miniplate failure, significant postoperative complications, and emergency MMF-miniplate release were observed. Only one case showed local soft tissue inflammation at the MMF-miniplate entry site, which resolved after removal. In conclusion, MMF-miniplate is a feasible, effective, and reliable technique with satisfactory clinical outcomes. This technique can be easily and quickly used as an alternative treatment for open reduction of condylar fractures or as a temporary MMF in complete/partial edentulous mandible to reduce difficult, complex, and time-consuming perioperative procedures.

Introduction: Mandibular fractures are the most common of all maxillofacial fractures and almost one third of these have mandibular angle fractures. Restoration of anatomic form and the union of bone fragments is of utmost important during the management of mandibular angle fractures and several methods have been discussed in the literature. Aim: To compare the transoral and extraoral approaches for the management of mandibular angle fractures in terms of postoperative outcomes including the incidence of postoperative pain, infection, scarring mouth opening and facial nerve injury. Materials and Methods: This retrospective study was performed in the Department of Plastic Surgery, Father Muller Medical College and Hopsital, Mangalore, Karnataka, India, from January 2019 to December 2021. A total of 21 patients were divided into two groups; transoral (n=12) and extraoral (n=9), based on the type of approach used for surgery. The outcomes were assessed in both groups in terms of postoperative outcomes including the incidence of postoperative pain, infection, scarring, mouth opening and facial nerve injury. Data were statistically analysed using appropriate statistical tests. Results: Out of the 21 patients studied, one patient in the extraoral group developed postoperative surgical site infection. There was a statistically significant difference in duration of surgery and postoperative mouth opening (p-value=0.006) and a highly significant difference in postoperative pain (p-value<0.001) and scar (p-value<0.001) between the two methods, proving transoral approach as effective method. Conclusion: The transoral approach is a better approach for fixation and management of mandibular angle fractures, as compared to the extraoral approach. [ABSTRACT FROM AUTHOR]

The Sub-condylar region is a common place for mandible fractures and these fractures can be managed by open reduction and internal fixation techniques, or only inter- maxillary fixations. The aim was to reveal the effects of healing of these fractures on clinical and radiologic findings. This is a clinical study including 15 patients. All patients had unilateral sub-condylar fractures and patients who had bilateral sub-condylar fractures, intra-articular fractures, or displaced mandible fractures that were located on another subpart were excluded. Clinical assessments include occlusion, maximum mouth opening at an interincisal distance, deviation of the mandible with mouth opening, and general oral and health assessment index. Radiologic assessments include the heights of the condyles and rami + condyles, and the distances between the mandible anguli and cranial base. Statistical tests have been performed. The patients' ages ranged between 9 and 70 years (mean:28.1±15.4). Follow-up period ranged between 6 and 74 months (mean: 28.3±27.2). 13 patients had normal occlusions. The mean maximum mouth opening was 4.3±0.69 centimeters. 11 patients had a mean mandibular deviation of 0.26±0.27 centimeters with mouth opening. Clinical effects of the fracture and healing period can be accepted as quite satisfying in both clinical and radiologic means with either treatment options including open reduction internal fixations and IMF/Arch-Bar-only techniques. Long-term results of sub-condylar region fractures are quite acceptable with a high level of quality of life. [ABSTRACT FROM AUTHOR]

Numerous techniques achieve maxillomandibular fixation (MMF), each with benefits and risks. While using Erich arch bars to achieve MMF has remained the gold standard through the last century, the technique has multiple limitations, which have spurred innovative approaches, such as intermaxillary fixation (IMF) screws, hybrid arch bars, embrasure wires, and dental occlusion ties. The surge in new MMF technologies over the past decade prompted this analysis to compare these techniques. A PubMed search was conducted to identify all current FDA-approved modern MMF technologies from 2005 through 2023, evaluating their advantages and limitations. Studies with controlled scientific comparisons of techniques were limited, precluding a systematic review. Analysis showed no definitive data exist to endorse one technique as a universal option. As multiple MMF options offer appropriate stability, a surgeon may choose an approach based upon numerous factors: comminution/instability; need for physiotherapy, including guiding elastics; safety; time of application/removal; and patient comfort. This article guides the selection between techniques based on these factors and presents a decision algorithm to assist surgeons in selecting the ideal MMF technique for each patient.

Like in orthopaedics, many maxillofacial fracture cases require elastic traction to control the muscle spasms, pain and aid in reduction of the fractured segments to achieve acceptable occlusion before the definitive management. In trauma and emergency hospital setup, sometimes conventional stock elastic bands are not readily available for the traction (non-rigid maxillo–mandibular fixation). In such cases, customized elastic bands, made from Foley's catheter, can be a better alternative. The current technique is hassle free and has ease of customization as per individual case due to easy availability of Foley's catheter in hospital setup.

Background: In maxillofacial trauma, the most commonly encountered are mandibular fractures requiring treatment. Managing these fractures with rigid fixation abolish the intermaxillary fixation (IMF) requirement with reduction and early return to function. Aims: The present trial was carried out to assess clinically the effectiveness of new locking bone plate screw system postsurgically in mandibular fracture cases without IMF. Materials and Methods: In 18 subjects, the fracture site was exposed, fracture segments were reduced and approximated keeping the occlusal relationship is desirable using locking 2 mm mini plates and screws without IMF. The subjects were followed every week for initial 4 weeks followed by evaluation for up to 6 months every month to assess clinical and radiographic healing and the results were formulated. Results: Road traffic accident was the cause in 10 subjects (55.5%), followed by assault in 22.2% (n = 4) subjects, and fall from height in 16.6% (n = 3) subjects. Parasymphysis was involved in 44.4% (n = 8), followed by symphysis in 11.1% (n = 2) subjects. A minor complication of wound dehiscence was seen in 5.5% (n = 1) subjects that were managed conservatively and a major complication of infection was also seen in 1 subject that required removal of the plate at 4 weeks of follow-up. Following plate removal, IMF was done for that subject. All other sites were healed uneventfully. Primary healing in bone was seen in 94.4% (n = 17) subjects and it was not seen in the case with infection. Conclusion: Within the limitations, the present study concluded that the locking miniplate system is highly effective and reliable in treating mandibular fractures with acceptable results and a very low postoperative complications rate. [ABSTRACT FROM AUTHOR]

Background: For maintaining the occlusion, screws to anchor bones are needed to be used in transalveolar manner to get the intermaxillary fixation in participants with no preoperative orthodontic treatment or participants with loose or broken appliances. Aims: The present clinical trial was hence aimed to assess the postoperative complications following orthognathic surgical repair of skeletal malocclusion. Materials and Methods: Forty-two participants were divided into two groups (n = 22). In Group I, predrill was done to create the holes in transalveolar position before screw insertion. For Group II, self-cutting screws were used without the drills. The radiographs were then taken to assess the associated root injuries. To evaluate the effect of different steroid doses on the pain, nerve healing, and swelling, the participants were divided into three groups (n = 14). Plate removal and associated factors were also evaluated. Collected data were statistically analyzed. Results: In Group where no predrill was done, no root injuries were seen. Considerably less facial edema was observed in Group II and III compared to control Group I. This difference was statistically significant with a P value of 0.2057. At 1 week, 3 months, and 6-month postoperatively in Group II and Group III, no significant difference was seen. No significant difference in the postoperative pain between the groups was seen (P = 0.85103). Neurosensory Visual Analog Score measurement revealed no significant difference between three groups at 6 months with the P value of 0.81821. Conclusion: The present study concludes that risk for the root injury is possessed by the screws that require predrill, whereas the self-drilling screws had no risk for root injury.

OBJECTIVE: The objective of the study was to evaluate the results and immediate postoperative complications following open reduction and internal fixation of mandibular fractures with or without postoperative maxillo-mandibular fixation MATERIALS AND METHODS: The study spanned over a period of 24 months, extending from October 2015 to October 2017. The study sample comprised 24 subjects between the age range of 18 to 65 years. They were randomly divided into two groups: Group A included subjects in whom open reduction and internal fixation was followed by maxilla-mandibular fixation for 15 days, and Group B subjects in whom only open reduction and internal fixation was done, followed by immediate mobilization. The outcomes evaluated were swelling, pain, simplified oral hygiene index and occlusion. The subjects were followed for all these outcomes on 1st, 7th and 15th days. The occlusion was assessed for 5 days. Any other intra/post-operative complications were additionally noted. RESULTS: There was no statistical difference between the groups for swelling, pain and occlusion. The patients with postoperative maxilla-mandibular fixation had poorer oral hygiene when compared to the other group (p<0.001). CONCLUSIONS: The use of maxilla-mandibular fixation post open reduction and internal fixation seems to offer no additional benefits to the patients. According to the results of the study, this traditional surgical dictum seems to be used by the surgeons due to the lack of any scientific evidence. However, further studies should be conducted to confirm this statement. [ABSTRACT FROM AUTHOR]

Ravish Mishra,1 Deepak Yadav,1 Shashank Tripathi,1 Laxmi Kandel,1 Pawan Puspa Baral,2 Snigdha Shubham,3 Abhishek Karn,4 Kishor Dutta5 1Department of Oral and Maxillofacial Surgery, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal; 2Department of Anaesthesiology and Critical Care, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal; 3Department of Conservative Dentistry and Endodontics, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal; 4Department of Forensic Medicine and Toxicology, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal; 5Department of Orthodontics and Dentofacial Orthopaedics, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, NepalCorrespondence: Ravish MishraDepartment of Oral and Maxillofacial Surgery, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, NepalTel +977 98 44616364Email drravishmishra84@gmail.comIntroduction: Airway management in patients with panfacial fracture remains a challenge to anesthesiologists and surgeons. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management.Methods: The descriptive retrospective study was carried out and evaluated the outcomes of submental intubation in the management of panfacial fracture, complex maxillary or mandible fracture associated with nasal bone fracture and naso-orbito-ethmoid (NOE) fracture. The medical records of 23 patients who received submental endotracheal intubation were reviewed at UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal from March 2014 to December 2018. The following parameters were evaluated: mode of trauma, time required for intubation, accidental extubation, accidental perforation of the pilot balloon during its insertion, period of hospital stay, post-operative complications, such as the healing of submental scars both intraorally and extraorally.Results: The submental intubation was successfully done in all patients with minimal obvious post-operative complications. The mode of trauma for majority of cases of panfacial fracture who underwent submental intubation was road traffic accident (69.56%). The mean time required for intubation was 8.43 (± 0.84) minutes. No accidental extubations occurred. Accidental perforation of the pilot balloon was seen in one patient (4.35%) during tube manipulation which was managed successfully by changing the tube. The healing of submental scars was uneventful intraorally and extraorally in almost every case. The mean period of hospital stay in patients with submental intubation was 7.95 (± 1.49) days.Discussion: Submental intubation is an effective and safe method as it is not associated with complications of tracheostomy during management of panfacial fracture, NOE fracture and craniofacial fracture. In addition, it does not interfere with IMF during intraoperative period.Keywords: panfacial fracture, submental intubation, intermaxillary fixation, airway management

Background: For maintaining the occlusion, screws to anchor bones are needed to be used in transalveolar manner to get the intermaxillary fixation in participants with no preoperative orthodontic treatment or participants with loose or broken appliances. Aims: The present clinical trial was hence aimed to assess the postoperative complications following orthognathic surgical repair of skeletal malocclusion. Materials and Methods: Forty-two participants were divided into two groups (n = 22). In Group I, predrill was done to create the holes in transalveolar position before screw insertion. For Group II, self-cutting screws were used without the drills. The radiographs were then taken to assess the associated root injuries. To evaluate the effect of different steroid doses on the pain, nerve healing, and swelling, the participants were divided into three groups (n = 14). Plate removal and associated factors were also evaluated. Collected data were statistically analyzed. Results: In Group where no predrill was done, no root injuries were seen. Considerably less facial edema was observed in Group II and III compared to control Group I. This difference was statistically significant with a P value of 0.2057. At 1 week, 3 months, and 6-month postoperatively in Group II and Group III, no significant difference was seen. No significant difference in the postoperative pain between the groups was seen (P = 0.85103). Neurosensory Visual Analog Score measurement revealed no significant difference between three groups at 6 months with the P value of 0.81821. Conclusion: The present study concludes that risk for the root injury is possessed by the screws that require predrill, whereas the self-drilling screws had no risk for root injury. [ABSTRACT FROM AUTHOR]

Introduction: Condyle fracture can be treated surgically (ORIF) or conservatively (CTR). When treated by CTR, the fracture might not heal in a morphologically ideal shape. The severity of the deformity and its effects on the functional outcome is not known. This study would investigate the anatomical outcome of CTR and its effect on the functional outcome. Methods: Using a cross-sectional study design, we enrolled patients identified from our trauma census that meets the pre-determined inclusion criteria. Patient underwent assessment which involves clinical and radiographic evaluation. Clinical examination was done by using Helkimo Index. Radiographic evaluation by using cone beam computed tomography (CBCT) scan were traced and digitized, and the position and morphology of the fractured mandibular condyle was measured and compared with those of the contralateral non-fractured condyle in the axial, coronal and sagittal planes. Radiographic data was then compared with data from clinical examination. Results: 25 patients with unilateral condyle fracture and met the inclusion criteria were identified. Eight patients were successfully recalled and included in the study. Assessment was done on average of 40 months post-treatment. Clinical assessment with Helkimo Index showed that 63% had at least mild temporomandibular symptoms or dysfunction. CBCT examinations revealed that most patients had morphologically deformed healed condyle. No pattern can be seen in the magnitude of deformity with functional outcome. Conclusions: Following CTR, condyle fracture would heal in a morphologically deformed shape. Satisfactory functional outcome is still attainable despite this. The magnitude of the deformity does not appear to influence the functional outcome. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective chart review., Objective: Restoration of premorbid occlusion is a key goal in the treatment of mandibular fractures. Placement of the patient in maxillomandibular fixation (MMF) is performed during mandibular fracture repair to help establish occlusion. A number of techniques are available to achieve MMF. We sought to examine trends in MMF technique at our institution., Methods: A retrospective chart review was conducted to evaluate patients who underwent surgical treatment of mandibular fractures between January 1, 2011 and March 31, 2021. Data including fracture characteristics, mechanism of injury, patient demographics, complication rates, and MMF technique utilized were collected., Results: One hundred sixty-three patients underwent MMF (132 males). The most common etiology of fracture was assault (34%). There was an increasing preference for rapid MMF techniques over time, as opposed to standard Erich arch bars. No significant difference in obtaining adequate fracture reduction as determined by postoperative imaging or complications were noted between those who underwent MMF with newer rapid techniques vs traditional MMF techniques., Conclusions: Our institution has demonstrated changing trends in the technique utilized for establishing occlusion intraoperatively, more recently favoring rapid MMF techniques, with similar rates of complications and ability to adequately reduce fractures., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C. Humphrey received a consulting fee from Invisian Medical LLC in 2021. All other authors deny any potential conflicts of interest., (© The Author(s) 2023.)

Aim and Objectives: To evaluate the pattern, prevalence, etiology, site of fractures, and their management in patients with maxillofacial injury in Delhi-NCR region. Materials and Methods: A total of 1278 maxillofacial trauma patients visiting different registered hospitals from Delhi-NCR region from January 2012 to December 2017, treated by open reduction and internal fixation under general anesthesia (GA)/local anesthesia (LA) or closed reduction/conservatively, were taken into the study. The parameters considered in the study were age and sex distribution, etiological factors and incidence of maxillofacial trauma, pattern and site distribution of maxillofacial fractures, and management. Results: From a total of 2250 trauma patients, 1278 patients (1053 males and 225 females) had maxillofacial injury. The average prevalence rate was 56.8%. Yearly incidence rate was 20.4%. Road traffic accident (RTA) was the most common cause of trauma in 1029 (80.5%) patients, followed by physical assault [158 (12.3%)] with significant male predominance in different age groups. Isolated mandibular fractures were the most common [48.6% (parasymphysis 31.6%, condyle 28.2%)], followed by midface with maxilla fracture [27.6% (zygomatic bone and arch 50.2% and Lefort II fractures 18%)]. Treatment modalities were conservative management, closed reduction, and open reduction with internal fixation under GA/LA. Conclusion: RTA followed by physical assault is still the leading cause of maxillofacial trauma in young males in Delhi-NCR region. Mini plate osteosynthesis is the main treatment procedure for maxillofacial trauma. We need to enforce strict traffic rules, road safety law, and preventive measures along with improvement in education and socioeconomic status in the population to avoid maxillofacial injuries.

Intermaxillary fixation (IMF) screws are commonly used for maxillomandibular immobilization in the management of mandible fractures as definitive closed reduction treatment or in adjunct intraoperatively. In this report, we present three cases of isolated unilateral mandible fractures, in which IMF screws were used and resulted in propagation of a second fracture on the contralateral side, at the site where IMF screws were placed during the surgery. The use of IMF screws has many advantages with an overall low risk of morbidity, however, there are potential complications that must be recognized. [ABSTRACT FROM AUTHOR]

Reconstructive outcomes after complete temporomandibular joint (TMJ) resection, including the condyle and glenoid fossa bone, are poorly defined in the literature. We described our technique and reviewed occlusion and functional outcomes of 6 consecutive patients undergoing complete TMJ resection and reconstruction with anterolateral thigh free tissue transfer and intermaxillary fixation with elastic bands for 6 to 8 weeks. At median follow-up of 14 months, median Mandibular Function Impairment Questionnaire score was 32 (range, 4-38), indicating mild to moderate impairment. Subjective occlusion was normal in 4 of 6 patients. Premature occlusal contact was seen in 2 of 6 patients. Maximal interincisor distance and horizontal mandibular shift with jaw abduction ranged from 29 to 40 mm and 5 to 8 mm, respectively. Four of 6 tolerated regular diets while 2 adhered to mechanical soft diets; no patients were feeding tube dependent. Soft tissue-only reconstruction after complete TMJ resection resulted in good subjective and objective occlusion in 4 of 6 patients and no cases of severe functional impairment. [ABSTRACT FROM AUTHOR]

Intermaxillary fixation of gunning splints with an archwire necessitates precision in removal, which can prove hazardous during a life‐threatening emergency. This case report describes the treatment of parasymphseal fracture of a patient hailing from remote location with inaccessibility to health care system. Intermaxillary fixation was performed with gunning splints using heavy orthodontic elastics, facilitating ease of removal in case of an emergency. [ABSTRACT FROM AUTHOR]

Introduction: Intermaxillary fixation (IMF) is regarded as a significant step in the management of maxillofacial trauma. Various techniques have been mentioned in the literature for achieving maxillomandibular fixation (MMF). The conventional methods such as arch bars and eyelet wiring are the most commonly used, but these methods have their own shortcomings. With the introduction of self-tapping MMF screws in 1989, many of the drawbacks with the use of arch bars can be eliminated. Hence, the aim of this study was to compare the efficiency of MMF screws over arch bars in achieving IMF. Materials and Methods: Thirty patients that required IMF as a part of their treatment and reported to the Department of Oral and Maxillofacial Surgery KLE VKIDS and Dr. Prabhakar Kore charitable hospital, K LE, Belgaum, were included in the study. Patients were divided randomly into two groups: Group A: Patients treated using MMF screws and Group B: Patients treated using arch bars. Statistical analysis was performed using the Mann–Whitney U-test and unpaired t-test. Results: There was a significant difference in oral hygiene index between the two groups at the end of the 14th postoperative day. The time taken for the placement of MMF screws was significantly less (mean 18.7 min) as compared to arch bars (mean 41.2 min). Screw loosening was seen in 4 (26%) out of 15 patients and 3 screws (4.5%) out of 66 screws used showed partial mucosal coverage at the end of 2 weeks. There were no cases of penetration injury in Group A, while in Group B, penetration injury to the surgeon was noted in 5 (33.3%) cases. Conclusion: MMF screws provided good intraoperative MMF. Placement of screws consumes less time and reduces the intraoperative period and also the risk of penetration injury to the surgeon. We also observed better oral hygiene, better patient compliance, and no major complications with the use MMF screws. Hence MMF screws proved to be an efficient alternative to the conventional methods of achieving IMF.

Aim: This clinical technique aims to retighten intermaxillary fixation (IMF) wires when loosened intra/postoperatively., Background: Intermaxillary fixation is one of the most important steps to obtain stable and functional occlusion in maxillofacial trauma. However, IMF wires tend to loosen over time. This loosened wire is generally removed and a new wire is used for IMF. Removal and refixation is time-consuming for surgeon and unconformable for the patient., Technique: We recommend a simple technique for re-tightening IMF wires without breakage, with the use of shepherd's crook explorer by making a small circular loop., Conclusion: This technique of re-tightening by looping further stretches and tightens the wire to regain stabilized occlusion with maximal intercuspation., Clinical Significance: This technique eliminates the need for removal and refixation of IMF wires, thereby improving patient comfort, yet obtaining stable occlusion over a long period of time. How to cite this article: Madhu SK, Dominic S, Baptist J, et al . Simple Method for Re-tightening IMF Wires without Breakage. J Contemp Dent Pract 2024;25(3):289-291.

Osteochondroma of condyle is an exophytic lesion that arises from the cortex of bone and is capped with cartilage. It is one of the most common benign tumors of the bone. It usually appears in endochondral bones. In the mandible, it occurs most frequently at the condyle or coronoid processes. There has been ambiguity in understanding the nature of osteochondroma, whether it is neoplastic or just a reactive phenomenon. Here, we are presenting a case report of a 43-year-old male patient with a chief complaint of deviation of jaw toward the right side and progressive facial asymmetry for the past 1 year. There was an asymmetric prognathism of the lower jaw with ipsilateral open bite and contralateral crossbite. The patient was planned for surgery under general anesthesia. The tumor was dissected from its soft-tissue attachments, and then, complete excision of the tumor was done. Histopathological examination of the lesion showed a proliferation of bony and hyalinized cartilage-like tissues. Two-year postoperative follow-up was uneventful, and no second surgical intervention was required. Computed tomography scan after 2-year follow-up revealed no reoccurrence of lesion, and the patient's facial profile was significantly improved. [ABSTRACT FROM AUTHOR]

Intermaxillary fixation (IMF) and osteosynthesis plates (OP) are widely used for the non-surgical and surgical treatment of mandible and condyle fractures. The aim of this retrospective study was to analyze the frequency of tooth root injuries by IMF and OP screws. Electronic patient reports (2004–2013) were screened for patients treated with either IMF screws and/or OP in the Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Germany. The frequency and the position of endangered and injured teeth were analyzed by orthopantomogram (OPTG) and cone beam computer tomography (CBCT). Next, possible predictive factors for tooth root injuries, namely interdental- and crestal distance, screw length and distance between tooth root and screw were evaluated. Further, the accuracy of OPTG vs. CBCT concerning the diagnosis of tooth root injuries was analyzed. Three-hundred sixty-six patients were included and 3388 teeth were defined as endangered by IMF- and OP screws. Overall, 16 injured teeth (0.5%) in 13 patients (3.55%) were detected. Nine injuries (56.3%) were caused by IMF- and seven injuries (43.8%) by OP screws. Three teeth were non-vital, one tooth had to be extracted. No correlation between the predictive factors crestal distance, screw length and tooth root injuries was found. If tooth injury occurred, a significant correlation between the interdental distance and the distance between tooth root and screw was found (κ = 0.48; p < 0,0001). Comparison between OPTG vs. CBCT demonstrated that many of the injuries that were seen in the OPTG (n = 230) could not be verified in the CBCT scans (n = 16) (κ = 0.12). To conclude, screws for IMF and OP can be considered as a safe procedure concerning the risk of tooth root injuries. • Screws for intermaxillary fixation are widely used in oral- and maxillofacial surgery. • Tooth root injuries are a possible risk when using screws for intermaxillary fixation. • Tooth root injuries were retrospectively found in nearly 4% of all patients. • Only in single cases were root canal treatment or extraction of affected teeth necessary. • CBCT was more precise in the detection of injured roots compared to orthopantomogram. [ABSTRACT FROM AUTHOR]

Aim: Comparative evaluation of efficacy of conventional arch bar, intermaxillary fixation screws, and modified arch bar with respect to plaque accumulation, time required for procedure, postoperative stability after achieving the intermaxillary fixation, mucosal growth, and complication encountered for intermaxillary fixation. Materials and methods: This study is a randomized clinical trial in which participants were divided into three groups of 10 each, and designated as Group A, Group B, and Group C. In Group A, intermaxillary fixation was achieved by the conventional method using Erich arch bar, fastened with 26-gauge stainless-steel wires. In Group B, intermaxillary fixation was achieved by the use of 2 mm × 8 mm 4–6 stainless-steel intermaxillary fixation screws. In Group C, intermaxillary fixation was achieved by modified screw arch bar. A conventional arch bar was modified by making perforations in the spaces between the winglets along the entire extension of the bar which was then adapted to the vestibular surface of the maxilla and mandible, close to the cervical portion of the teeth, and perforations were made in the inter-radicular spaces with a 1.1-mm bur, and after this, 1.5-mm screws were placed to fix the bar. Results: In the present study, a total of 30 patients were analyzed. The average working time for Group A, Group B, and Group C were 110, 16, and 29 min respectively. Oral hygiene scores through modified Turskey Gilmore plaque index which was taken at immediate postoperative, 15, 30, and at 45 days. Maximum hygiene was maintained in intermaxillary fixation screw group followed by modified arch bar group and conventional arch bar group. Maximum stability was seen in the conventional arch bar group followed by modified arch bar group and intermaxillary fixation screw group. With respect to mucosal coverage, maximum mucosal growth was seen in intermaxillary fixation screws group. When complications were taken into consideration, maximum complications were reported in Group A followed by Group B and Group C. Conclusion: This study emphasizes that the use of modified arch bar is quick and easy method than conventional arch bar with least chances of glove puncture and needle stick injury to the operator. Oral hygiene maintenance is comparatively better in patients with modified arch bar than with conventional arch bars. Modified arch bar was significantly stable when compared with IMF screws, and therefore, for the patients who require long-term intermaxillary fixation, modified arch bars can be a viable option. [ABSTRACT FROM AUTHOR]

This study was conducted to assess the usefulness of thermography for quantifying facial temperature before and after orthognathic surgery and intermaxillary fixation, and the effects of these orthognathic procedures on facial temperature. Facial thermograms of 10 patients who underwent bilateral sagittal split ramus osteotomy (SSRO, one-jaw group) and another 10 patients who underwent Le Fort I osteotomy and bilateral SSRO (two-jaw group) were taken 1 day before orthognathic surgery (T1) and at release of intermaxillary fixation 7 days later (T2). Two thermograms taken 30 s (TG1) and 3 min (TG2) after the start of recording at T1 and T2 were used. A square (26 × 26 pixels) was marked on each thermogram and the mean facial temperature for each square was measured. Three-way analysis of variance was used for statistical comparisons. Facial temperatures were significantly higher at T2 than at T1 on TG1 and TG2, and were significantly higher on TG2 than on TG1 at T1 and T2. The two-jaw group had a significantly higher facial temperature than the one-jaw group. Thermography was useful for quantitative assessment of facial temperature in patients undergoing orthognathic surgery. Changes in facial temperature were due predominantly to inflammation after surgery, rather than to sarcopenia. [ABSTRACT FROM AUTHOR]

Aim and Objectives: To evaluate the pattern, prevalence, etiology, site of fractures, and their management in patients with maxillofacial injury in Delhi-NCR region. Materials and Methods: A total of 1278 maxillofacial trauma patients visiting different registered hospitals from Delhi-NCR region from January 2012 to December 2017, treated by open reduction and internal fixation under general anesthesia (GA)/local anesthesia (LA) or closed reduction/conservatively, were taken into the study. The parameters considered in the study were age and sex distribution, etiological factors and incidence of maxillofacial trauma, pattern and site distribution of maxillofacial fractures, and management. Results: From a total of 2250 trauma patients, 1278 patients (1053 males and 225 females) had maxillofacial injury. The average prevalence rate was 56.8%. Yearly incidence rate was 20.4%. Road traffic accident (RTA) was the most common cause of trauma in 1029 (80.5%) patients, followed by physical assault [158 (12.3%)] with significant male predominance in different age groups. Isolated mandibular fractures were the most common [48.6% (parasymphysis 31.6%, condyle 28.2%)], followed by midface with maxilla fracture [27.6% (zygomatic bone and arch 50.2% and Lefort II fractures 18%)]. Treatment modalities were conservative management, closed reduction, and open reduction with internal fixation under GA/LA. Conclusion: RTA followed by physical assault is still the leading cause of maxillofacial trauma in young males in Delhi-NCR region. Mini plate osteosynthesis is the main treatment procedure for maxillofacial trauma. We need to enforce strict traffic rules, road safety law, and preventive measures along with improvement in education and socioeconomic status in the population to avoid maxillofacial injuries. [ABSTRACT FROM AUTHOR]

Background/Aims: Open reduction and internal fixation (ORIF) is a standard surgical procedure in jaw trauma and in orthognathic surgery. Insertion of screws is a significant risk for accidental tooth root injury with varying outcomes. Contrary evidences are found in literature due to a variety of study designs. This study was undertaken to address the lacunae and possibly estimate the difference in occurrence of tooth damage during or after ORIF between trauma and planned osteotomies. Materials and Methods: In this retrospective study, the data of ORIF in either trauma or orthognathic surgery fulfilling inclusion and exclusion criteria were collected and analyzed. Results: There were 1632 patients fulfilling the inclusion and exclusion criteria and formed the study group, of which 663 were in orthognathic surgery, of whom 210 had bimaxillary orthognathic surgery. In the trauma group, 358 patients had fractures involving both jaws whereas 272 had maxilla alone and 339 had mandibular fractures alone. On comparing the outcome, of the 9073 screws studied, 93.40% were not involved in any contact with the teeth, 6.3% were in category of potential hits (near apices or the root surfaces), and only 0.28% had evidence of root damage with the screws. It is observed that molar and premolar had a significant difference in terms of the type of surgery (P ≤ 0.05) whereas canine (P = 0.75) and incisor (P = 0.67) showed no statistical difference. Conclusion: ORIF when used as mentioned is a safe way for the management of fractures. The incidence of root injury is not uncommon but can be avoided with careful planning and execution.

Introduction. Intermaxillary fixation is an important and inseparable constituent part of treatment of trauma patients which provides an adequate interocclusal relationship. It can be employed as a solely conservative moda lity for fracture treatment as well as obligatory assistance of jaw osteosynthesis in case of its traumatic injury. The essential drawbacks of the existing methods of intermaxillary fixation, particularly dental arch bars and ligatures, are negative infl uence on periodontium, complicated hygiene, non-balanced muscular loading, pain and psychological discomfort to the patient etc, which requires a search for alternative methods. A stream development and inculcation to the clinical practice of various orthodontic systems in recent decades allow extrapolating the indications for their employment from orthodontics to other dental directions, especially maxillofacial traumatology. The purpose of the study is a retrospective analysis with clarification of historical aspects and generalization of own experience of employment of non-removable orthodontic technique (bracket system) for fixation of bone fragments in cases of traumatic mandibular fractures. Materials and research methods. Since 2012 in the Department of Surgical Dentistry and Maxillofacial Surgery of The Danylo Galytsky LNMU 57 patients (men – 45, women – 12; age 18 – 45) with traumatic mandibular fractures were examined and treated surgically (control group, 35 patients) and conservatively (main group, 22 patients). In all patients of the main group the intermaxillary fixation was carried out using the elements of non-removable orthodontic technique – brackets VictoryÒ with hooks (specification 0° TQ, 0° ANG, 022) (3М Unitek, USA), which were fixed on teeth according to standard protocol, including acid enamel etching, employment of adhesive, fixation of brackets with light-curing composite). Later the hooks of opposite brackets were joined together by elastic rubber rings in proper occlusal relationship. Control inspection of patients was carried out on 1, 3, 7, 14, 21, 30, 60 and 90 days post-operatively. Results. The obtained results of employment of non-removable orthodontic elements (brackets) for bone fragments fixation in 22 patients with traumatic mandibular fractures were evaluated by us as satisfactory. The mean period of intermaxillary fixation was 19 ± 2 days. On that time clinical and roentgenological signs of fracture consolidation were observed in all patients and there were no occlusal disturbances in any case as well as other complications except of unglue of brackets from the teeth surface. There were no patients’ complaints regarding laboured oral hygiene and service of orthodontic appliance. Positive results of investigation are confirmed by the demonstration and description of a clinical case. Conclusions. Summarizing the results of a brief retrospective literary analysis as well as our own clinical experience it could be asserted that employment of elements of non-removable orthodontic technique (bracket system) for fixation of bone fragments in cases of traumatic mandibular fractures creates a serious alternative to the existing methods of an intermaxillary fixation. The proposed method allows to reestablish an adequate anatomical and functional status of the mandible in short terms, facilitates oral hygienic maintenance, requires no local anaesthesia and is suitable for both balanced occlusal loading distribution and, oppositely, correction of occlusal relationship by means of directed elastic pull.

Introduction: One of the treatment techniques for mandibular and midface fractures is intermaxillary fixation (IMF), but treatment with IMF interferes with normal nutrition, and malnutrition can affect the result of the treatment and patient’s recovery. Methods: Paraclinical factors including lipid profile and protein profile indexes which are diagnostic for malnutrition were evaluated in this study to point out how treatment with IMF changes these indexes. In this study, 60 patients were treated with 4 weeks of IMF, the lipid profile and protein profile indexes for these patients were measured before and after the treatment. Results: The albumin (Alb) decreased during this period, but a slight increase was shown in the hemoglobin (Hb) level. All lipid profile indexes such as low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), and total cholesterol (TC) decreased during this period but not statistically significant.Conclusion: Treatment with IMF could cause a malnutrition situation although not severe, which makes using nutrition supplements considerable in these cases.