The Use of Screw Retained Hybrid Arch Bar for Maxillomandibular Fixation in the Treatment of Mandibular Fractures: A Comparative Study

Saif T Hamid, Salwan Y Bede, Saif T Hamid, Salwan Y Bede

Abstract

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.

Keywords: Erich arch bar; hybrid arch bar; mandibular fractures; maxillomandibular fixation; postoperative complications.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2022 Annals of Maxillofacial Surgery.

Figures

Figure 1
Figure 1
Erich arch bar for maxillomandibular fixation of mandibular fracture
Figure 2
Figure 2
Smart Lock Hybrid arch bar for maxillomandibular fixation of mandibular fracture
Figure 3
Figure 3
Flow diagram of the progress through the phases of the study for both groups
Figure 4
Figure 4
Clinical view showing mucosal growth over the screw

References

    1. Kendrick DE, Park CM, Fa JM, Barber JS, Indresano AT. Stryker SMARTLock hybrid maxillomandibular fixation system: Clinical application, complications, and radiographic findings. Plast Reconstr Surg. 2016;137:142e–50.
    1. King BJ, Christensen BJ. Hybrid arch bars reduce placement time and glove perforations compared with Erich arch bars during the application of intermaxillary fixation: A randomized controlled trial. J Oral Maxillofac Surg. 2019;77:1228.e1–8.
    1. Ingole PD, Garg A, Shenoi SR, Badjate SJ, Budhraja N. Comparison of intermaxillary fixation screw versus eyelet interdental wiring for intermaxillary fixation in minimally displaced mandibular fracture: A randomized clinical study. J Oral Maxillofac Surg. 2014;72:958.e1–7.
    1. Sekar K, Natarajan PM, Kapasi A. Comparison of arch bar, eyelets and transmucosal screws for maxillo mandibular fixation in jaw fracture. Biomed Pharmacol J. 2017;10:497–508.
    1. Rai A, Datarkar A, Borle RM. Are maxillomandibular fixation screws a better option than Erich arch bars in achieving maxillomandibular fixation? A randomized clinical study. J Oral Maxillofac Surg. 2011;69:3015–8.
    1. Sandhu YK, Padda S, Kaur T, Dhawan A, Kapila S, Kaur J. Comparison of efficacy of transalveolar screws and conventional dental wiring using Erich arch bar for maxillomandibular fixation in mandibular fractures. J Maxillofac Oral Surg. 2018;17:211–7.
    1. Rothe TM, Kumar P, Shah N, Shah R, Mahajan A, Kumar A. Comparative evaluation of efficacy of conventional arch bar, intermaxillary fixation screws, and modified arch bar for intermaxillary fixation. J Maxillofac Oral Surg. 2019;18:412–8.
    1. Chao AH, Hulsen J. Bone-supported arch bars are associated with comparable outcomes to Erich arch bars in the treatment of mandibular fractures with intermaxillary fixation. J Oral Maxillofac Surg. 2015;73:306–13.
    1. Rani EB, Reddy VS, Amarnath K, Kumar S, Visalakhshi G. Bone supported arch bar versus Erich arch bar for intermaxillary fixation: A comparative clinical study in maxillofacial fractures. Int J Curr Res. 2018;10:69848–50.
    1. Bouloux GF. Does the use of hybrid arch bars for the treatment of mandibular fractures reduce the length of surgery? J Oral Maxillofac Surg. 2018;76:2592–7.
    1. Jain A, Taneja S, Rai A. What is a better modality of maxillomandibular fixation: bone-supported arch bars or Erich arch bars? A systematic review and meta-analysis. Br J Oral Maxillofac Surg. 2021;59:858–66. doi: 10.1016/j.bjoms. 2021.01.004.
    1. Schulz KF, Altman DG, Moher D CONSORT Group. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.
    1. Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963;21:533–51.
    1. Ferreira PC, Amarante JM, Silva PN, Rodrigues JM, Choupina MP, Silva AC, et al. Retrospective study of 1251 maxillofacial fractures in children and adolescents. Plast Reconstr Surg. 2005;115:1500–8.
    1. Kontio R, Suuronen R, Ponkkonen H, Lindqvist C, Laine P. Have the causes of maxillofacial fractures changed over the last 16 years in Finland? An epidemiological study of 725 fractures. Dent Traumatol. 2005;21:14–9.
    1. Bell RB. The role of oral and maxillofacial surgery in the trauma care center. J Oral Maxillofac Surg. 2007;65:2544–53.
    1. Morio W, Kendrick DE, Steed MB, Stein KM. The omnimax MMF system: A cohort study for clinical evaluation. Preliminary results of an ongoing study. J Oral Maxillofac Surg. 2018;76:e79–80.
    1. Avery CM, Johnson PA. Surgical glove perforation and maxillofacial trauma: To plate or wire? Br J Oral Maxillofac Surg. 1992;30:31–5.
    1. Pieper SP, Schimmele SR, Johnson JA, Harper JL. A prospective study of the efficacy of various gloving techniques in the application of Erich arch bars. J Oral Maxillofac Surg. 1995;53:1174–6.
    1. Gaujac C, Ceccheti MM, Yonezaki F, Garcia IR, Jr, Peres MP. Comparative analysis of 2 techniques of double-gloving protection during arch bar placement for intermaxillary fixation. J Oral Maxillofac Surg. 2007;65:1922–5.
    1. Qureshi AA, Reddy UK, Warad NM, Badal S, Jamadar AA, Qurishi N. Intermaxillary fixation screws versus Erich arch bars in mandibular fractures: A comparative study and review of literature. Ann Maxillofac Surg. 2016;6:25–30.
    1. Kumar P, Menon G, Rattan V. Erich arch bar versus hanger plate technique for intermaxillary fixation in fracture mandible: A prospective comparative study. Natl J Maxillofac Surg. 2018;9:33–8.
    1. Pathak P, Thomas S, Bhargava D, Beena S. A prospective comparative clinical study on modified screw retained arch bar (SRAB) and conventional Erich's arch bar (CEAB) Oral Maxillofac Surg. 2019;23:285–9.
    1. Khelemsky R, Powers D, Greenberg S, Suresh V, Silver EJ, Turner M. The hybrid arch bar is a cost-beneficial alternative in the open treatment of mandibular fractures. Craniomaxillofac Trauma Reconstr. 2019;12:128–33. [doi: 10.1055/s-0038-1639351]

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner