Erich arch bar versus hanger plate technique for intermaxillary fixation in fracture mandible: A prospective comparative study

Patient outcomes and complications following various maxillomandibular fixation techniques: A systematic review and meta-analysis

PURPOSE

Currently, there are several methods of achieving maxillomandibular fixation (MMF), each with its unique operative considerations and subsequent patient outcomes and complications. In this study, we reviewed the literature to evaluate and compare all MMF methods.

METHODS

A systematic review of all MMF types was conducted and post-operative outcome data were analyzed and compared among the different types. Conventional Erich arch bars were compared to hybrid arch bars, MMF screws, and eyelet interdental wiring. A random-effects meta-analysis was used to determine the mean differences, and 95% confidence intervals (CIs) with a statistical significance of P < 0.05.

RESULTS

Among the 4234 articles identified, 24 were included, and 17 were meta-analyzed. Time to achieve MMF (-43.38 min; 95% CI, -58.20 to -28.56; P < 0.001), total operative time (-30.33 min; 95% CI, -61.05 to 0.39; P = 0.05), incidence of wire puncture injuries and glove perforations (0.11; 95% CI, 0.04 to 0.30; P < 0.001), and incidence of poor oral hygiene (0.08; 95% CI, 0.02 to 0.28; P < 0.001) were lower for alternative MMF interventions compared to those of the conventional Erich arch bars.

CONCLUSIONS

Alternative MMF methods required shorter operative time to achieve MMF and demonstrated other increased efficiencies of practice such as shorter total operative time and decreased glove perforations, when compared to conventional Erich arch bars. If a patient is a candidate for MMF, the presented alternative MMF techniques should be considered depending on the clinical context and availability of institutional resources.

Comparison of Efficacy and Safety of Hybrid Arch Bar with Erich Arch Bar in the Management of Mandibular Fractures: A Randomized Clinical Trial

Study Design

A clinical randomized control trial.

Objective

To compare the efficacy and safety of Hybrid arch bar (HAB) with Erich arch bar (EAB) in fracture management of the mandible.

Methods

In this randomized clinical trial, 44 patients were divided into 2 groups:- Group 1, N = 23 (EAB group) and Group 2, N = 21 (HAB group). The primary outcome was time taken for the application of arch bar, while the inner and outer glove puncture, operator prick, oral hygiene, arch bar stability, complications of HAB, and cost comparison were secondary outcomes.

Results

The time taken for the application of arch bar in group 2 was significantly shorter than group 1 (55.66 ± 17.869 min vs 82.04 ± 12.197 min) and the frequency of outer glove puncture was also significantly lesser for group 2 (0 punctures vs 9 punctures). Better oral hygiene was found in group 2. EAB was cost-effective than HAB (Rs 700 ± 239.79 vs Rs 1742.50 ± 257.14). The stability of the arch bar was comparable in both groups. Group 2 had associated complications of root injury in 2 out of 252 screws placed and the screw head got covered by soft tissue in 137 out of 252 screws placed.

Conclusions

Thus, HAB was better than EAB with a shorter time of application, less risk of prick injury, and improved oral hygiene.Clinical trial registry name- clinical trials registry- India, URL-http://ctri.nic.in, registration number- CTRI/2020/06/025966.

Compare the Efficacy of Open Reduction and Internal Fixation of Mandibular Fractures With and Without Use of Intra-Operative Inter-Maxillary Fixation

Mandible fractures are regularly encountered by maxillofacial surgeons and various treatment protocols are available for the management of these fractures. The aim of study compares the efficacy of open reduction and internal fixation of mandibular fractures with and without use of intra-operative inter-maxillary fixation. Twenty patients between age group ranging l8-65 years who reported with single mandibular fracture in Dental college in India, during Oct 2012-March 2015 were the study subjects. These patients were divided into two groups. In one group fracture reduction was done by using inter-maxillary fixation and miniplate fixation was done. In other group fracture reduction was done manually and then fractured fragments were held in position by the assistant and miniplate fixation was done. Post-operatively patients were evaluated for occlusion, bone alignment and soft tissue/hard tissue infection at 1st, 4th, 8th, 12th weeks in both the groups. Statistics done by using Spearman's Rank correlation coefficient and Mann-Whitney U test. It was observed thatthere was no statistically significant difference seen in both the groups in terms of post-operative occlusion, radiological alignment and soft/hard tissue infection. Statistically significant difference was seen when the mean operating time was compared. The Group A showed mean difference of 35.50 min more time than Group B. The results of our study suggested that, use of intra-operative IMF does not show any advantages in terms of post-operative occlusion, bone alignment and soft/hard tissue infection. We have concluded from the study that the increased intra-operative time for the placement of IMF increases the cost of the surgery in regard to equipment and theatre time. There is no benefit in terms of radiographic and clinical outcome. Hence use of intra-operative IMF can be avoided for ORIF of single mandibular fracture.

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.

The use of screw retained hybrid arch bar for maxillomandibular fixation in the treatment of mandibular fractures: A comparative study

Introduction:

The use of screw-retained hybrid arch bars (HABs) is a relatively recent development in the treatment of mandibular fractures. The purpose of this study is to compare the clinical outcome between HAB and the conventional Erich arch bar (EAB) in the closed treatment of mandibular fractures.

Materials and Methods:

This study included 18 patients who were treated for mandibular fractures with maxillomandibular fixation (MMF), patients were randomly assigned into a control group (n = 10) in which EAB was used and study group (n = 8) in which HAB was used. The outcome variables were time required for application and removal, gingival inflammation scores, postoperative complications, and incidence of wire-stick injury or gloves perforation. The groups were compared using unpaired t-test, Mann–Whitney test, Chi-square test, or Fisher test. The differences were considered significant at P < 0.05.

Results:

The mean application time was significantly more in EAB than HAB (61.6 ± 11.4 vs. 41.6 ± 6 min, respectively). The mean time of removal for EAB was significantly less than HAB (11.1 ± 2 vs. 14.2 ± 3 min, respectively). There was nonsignificant difference in gingival inflammation between the groups. No major complications were recorded. Screw loosening and mucosal overgrowth were recorded in 12.5% and 31.2% of the screws, respectively, in HAB group. The incidence of gloves tear in EAB group was 70%.

Discussion:

HAB can be used as an alternative to EAB for MMF in patients with mandibular fracture, it requires less time for application and provides more safety for the surgeons.