MANDIBULOMAXILLARY FIXATION WITH BONE ANCHORS AND QUICK-RELEASE LIGATURES

Mandibulomaxillary fixation (MMF) is an essential technique for accura te treatment of maxillary and mandibular fractures. Traditional techni ques of obtaining MMF (circumdental wires and load-distributing arch b ars with or without plastic splints) often work poorly in children and adults with partial or absent dentition, require significant operativ e time, are at risk for glove puncture, and are painful to patients at time of removal. We have developed two new techniques for the rapid e stablishment of MMF in all ages and all types of dentition with or wit hout splints. These techniques use four bone anchors-two placed in the pyriform rim of the maxilla and two in the mandibular symphysis. ''Mi crolugs'' are anchors constructed from Luhr Vitallium mesh and are fix ated to bone with 0.8mm microscrews in primary- and mixed-dentition pa tients. Mitek MiniGII bone anchors are placed for treatment of seconda ry-dentition patients. Central skeletal MMF is achieved by linking eac h maxillary bone anchor to each mandibular bone anchor with suture lig atures and heavy orthodontic elastics. In this study, 112 patients (ag e range, 15 months-75 years) with maxillary and mandibular fractures u nderwent central skeletal MMF with one of the two new techniques descr ibed. Central skeletal MMF was maintained intraoperatively and for up to 6 weeks postoperatively, according to pathological anatomy. Our tec hniques succeeded with primary, mixed, and secondary dentition, and wi th splints and dentures, resulting in functional bone healing in 110 o f 112 patients. Malocclusion occurred in 2 patients (1.8%), constituti ng treatment failure. Microlug central skeletal MMF required 15 to 20 minutes to place, and Mitek anchor central skeletal MMF required 7 to 12 minutes to place. There were no glove punctures noted during the co urse of treatment, Patient satisfaction has been clearly superior with these two techniques, since MMF may be released in the office with mi nimal discomfort, even without topical anesthesia.