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Simple way of fixing a Gunning-type splint to the bone using intermaxillary fixation screws: technical note
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British Journal of Oral and Maxillofacial Surgery 51 (2013) e59–e60
Technical note
Simple way of fixing a Gunning-type splint to the bone using intermaxillary fixation screws: technical note Vilas Newaskar ∗ , Deepak Agrawal, Faisal Idrees, Poornima Patel Department of Oral and Maxillofacial Surgery, Government College of Dentistry, Indore, India Accepted 13 April 2012 Available online 4 May 2012
Keywords: IMF screws; Edentulous; Gunning-type splint
Undisplaced or minimally displaced fractures of the mandible in elderly patients are usually treated by closed reduction. Gunning-type splints or the patient’s old dentures are commonly used to achieve intraoral reduction of fractured bony fragments. Skeletal wiring is usually used to fix these splints to the bone. However, this carries the risk of injury to the facial artery, the lingual nerve, the submandibular duct, and other vital structures. We describe a simple technique for fixing these splints to bone with the help of intermaxillary (IMF) screws.
Case report Fig. 1. Intermaxillary fixation screws stabilising the maxillary denture.
A 61-year-old man presented with a history of falling from a height on the previous day. His orthopantograph showed bilateral condylar fractures. He was edentulous and wore complete dentures. His dentures were intact after the injury, so we decided to use them as splints. We used IMF screws to fix them to the bone instead of skeletal wiring. The anterior vestibular region and the anterolateral transitional zones (canine and premolar) are often considered ideal for screw placement because of convinient accessibility of these regions [1–3] and also to avoid proximity to the floor of the maxillary sinus which, in old age, is lower because of atrophy of the ridge. ∗
Corresponding author. Tel.: +91 9827028864. E-mail address: [email protected] (V. Newaskar).
Holes were drilled in these regions through the denture into the maxilla, and directly on to the mandible because of inadequate vestibular extension of the mandibular denture. IMF screws were tightened with a screwdriver through the maxillary denture into the bone. The denture was fixed rigidly to the maxilla. The posterior teeth on the denture served as a guide for maintenance of the vertical height. The mandibular denture was then placed on to the mandible and fixation achieved with the help of elastics (Fig. 1). The fixation achieved was satisfactory and was retained for 4 weeks. The operating and anaesthetic time was short and there were no major complications.
0266-4356/$ – see front matter © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2012.04.075
e60
V. Newaskar et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e59–e60
References 1. Cornelius CP, Ehrenfeld M. The use of MMF screws: surgical technique, indications, contraindications, and common problems in review of the literature. Craniomaxillofac Trauma Reconstr 2010;3:55–8.
2. Thota LG, Mitchell DA. Cortical bone screws for maxillomandibular fixation in orthognathic surgery. Br J Orthod 1999;26:325. 3. Sahoo NK, Mohan R. IMF screw: an ideal intermaxillary fixation device during open reduction of mandibular fracture. J Maxillofac Oral Surg 2010;9:170–2.
British Journal of Oral and Maxillofacial Surgery 51 (2013) e59–e60
Technical note
Simple way of fixing a Gunning-type splint to the bone using intermaxillary fixation screws: technical note Vilas Newaskar ∗ , Deepak Agrawal, Faisal Idrees, Poornima Patel Department of Oral and Maxillofacial Surgery, Government College of Dentistry, Indore, India Accepted 13 April 2012 Available online 4 May 2012
Keywords: IMF screws; Edentulous; Gunning-type splint
Undisplaced or minimally displaced fractures of the mandible in elderly patients are usually treated by closed reduction. Gunning-type splints or the patient’s old dentures are commonly used to achieve intraoral reduction of fractured bony fragments. Skeletal wiring is usually used to fix these splints to the bone. However, this carries the risk of injury to the facial artery, the lingual nerve, the submandibular duct, and other vital structures. We describe a simple technique for fixing these splints to bone with the help of intermaxillary (IMF) screws.
Case report Fig. 1. Intermaxillary fixation screws stabilising the maxillary denture.
A 61-year-old man presented with a history of falling from a height on the previous day. His orthopantograph showed bilateral condylar fractures. He was edentulous and wore complete dentures. His dentures were intact after the injury, so we decided to use them as splints. We used IMF screws to fix them to the bone instead of skeletal wiring. The anterior vestibular region and the anterolateral transitional zones (canine and premolar) are often considered ideal for screw placement because of convinient accessibility of these regions [1–3] and also to avoid proximity to the floor of the maxillary sinus which, in old age, is lower because of atrophy of the ridge. ∗
Corresponding author. Tel.: +91 9827028864. E-mail address: [email protected] (V. Newaskar).
Holes were drilled in these regions through the denture into the maxilla, and directly on to the mandible because of inadequate vestibular extension of the mandibular denture. IMF screws were tightened with a screwdriver through the maxillary denture into the bone. The denture was fixed rigidly to the maxilla. The posterior teeth on the denture served as a guide for maintenance of the vertical height. The mandibular denture was then placed on to the mandible and fixation achieved with the help of elastics (Fig. 1). The fixation achieved was satisfactory and was retained for 4 weeks. The operating and anaesthetic time was short and there were no major complications.
0266-4356/$ – see front matter © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2012.04.075
e60
V. Newaskar et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e59–e60
References 1. Cornelius CP, Ehrenfeld M. The use of MMF screws: surgical technique, indications, contraindications, and common problems in review of the literature. Craniomaxillofac Trauma Reconstr 2010;3:55–8.
2. Thota LG, Mitchell DA. Cortical bone screws for maxillomandibular fixation in orthognathic surgery. Br J Orthod 1999;26:325. 3. Sahoo NK, Mohan R. IMF screw: an ideal intermaxillary fixation device during open reduction of mandibular fracture. J Maxillofac Oral Surg 2010;9:170–2.