Mandibulomaxillary fixation with bone anchors and quick-release ligatures

Mandibulomaxillary fixation (MMF) is an essential technique for accurate treatment of maxillary and mandibular fractures. Traditional techniques of obtaining MMF (circumdental wires and load-distributing arch bars with or without plastic splints) often work poorly in children and adults with partial or absent dentition, require significant operative 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 establishment of MMF in all ages and all types of dentition with or without splints. These techniques use four bone anchors--two placed in the pyriform rim of the maxilla and two in the mandibular symphysis. "Microlugs" are anchors constructed from Luhr Witallium mesh and are fixated to bone with 0.8-mm microscrews in primary- and mixed-dentition patients. Mitek MiniGII bone anchors are placed for treatment of secondary-dentition patients. Central skeletal MMF is achieved by linking each maxillary bone anchor to each mandibular bone anchor with suture ligatures and heavy orthodontic elastics. In this study, 112 patients (age range, 15 months-75 years) with maxillary and mandibular fractures underwent central skeletal MMF with one of the two new techniques described. Central skeletal MMF was maintained intraoperatively and for up to 6 weeks postoperatively, according to pathological anatomy. Our techniques succeeded with primary, mixed, and secondary dentition, and with splints and dentures, resulting in functional bone healing in 110 of 112 patients. Malocclusion occurred in 2 patients (1.8%), constituting 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 course of treatment. Patient satisfaction has been clearly superior with these two techniques, since MMF amy be released in the office with minimal discomfort, even without topical anesthesia.