Intermaxillary fixation with two loop wires: the Rai technique

Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review

Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.

Simple Method for Re-tightening IMF Wires without Breakage

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.

Is the Use of Intermaxillary Fixation Screws an Alternative to Erich Arch Bars for Maxillomandibular Fixation During Management of Maxillofacial Fractures? A Systematic Review and Meta-Analysis

Study Design

Systematic review and meta-analysis.

Objective

Maxillomandibular fixation (MMF) is a step of paramount importance during the management of maxillofacial trauma. Erich arch bars are being used for this purpose for decades but with advances in maxillofacial trauma management, intermaxillary fixation screws came into existence and are being used routinely. The present study was designed to identify if the intermaxillary fixation screws are really an alternative to Erich arch bars for management of maxillofacial trauma.

Methodology

An exhaustive literature search was conducted in May 2020 on various electronic databases and studies comparing Erich arch bars and intermaxillary fixation screws were recruited for the analysis. Random-effects model with Mantel Haenszel statistics was used to analyze oral hygiene and duration of achieving MMF.

Results

A total of 96 studies were identified, out of which 8 studies were included in the meta-analysis. There was no statistically significant difference in oral hygiene status of the patients in both the groups. Intermaxillary fixations screws required statistically significantly less time in achieving MMF. Needle stick injury was prominently seen with the use of Erich arch bar whereas other complications like mucosal coverage, root injury, screw loosening and screw fracture makes the use of intermaxillary fixation screws questionable.

Conclusion

The present meta-analysis suggests that there is not enough evidence to recommend the use of intermaxillary fixation screws as an alternative to Erich arch bars. Further research with large sample size, high quality evidence and better methodology is recommended in this direction.

What is a better modality of maxillomandibular fixation: bone-supported arch bars or Erich arch bars? A systematic review and meta-analysis

Any procedure that aims to manage maxillofacial fracture is incomplete without meticulous maxillomandibular fixation (MMF). For decades, Erich arch bars (EABs) have been used for this purpose, but with the advent of bone-supported arch bars (BSABs), more surgeons now prefer them to conventional EABs. The present study was designed to identify which of the two methods is best. An exhaustive literature search was conducted in June 2020 on various electronic databases to select studies that compared EABs and BSABs. Outcomes such as duration of placement, stability, oral hygiene, and complications such as damage to the roots of teeth and needle-stick injury, were analysed. A total of 716 studies were identified, of which seven were eligible for inclusion. The meta-analysis showed that the use of BSABs is significantly faster with no needle penetration and better oral hygiene. Both arch bars are equally stable, but root damage is an associated complication. The available literature to date shows that BSABs are a better option than EABs. However, further research is recommended, as these studies are associated with various confounding factors.