Maxillofacial Fracture Case Study

Description of clinical problem
Maxillofacial fractures are usually caused by violence, road traffic accidents, falls, and sports . Pattern and etiology of maxillofacial injuries differ based on geographical, socioeconomic, population mobility, cultural, legislative, and environmental factors . These traumas can cause airway obstruction, intracranial damages, vision loss and other functional deficits . Level 1 of the AO Classification System categorizes the fractures of craniomaxillofacial skeleton into 4 anatomical units: mandible, midface, skull base, and cranial vault . Some high-energy trauma may result in panfacial fractures.

Mandibular fractures: Among all the maxillofacial fractures, the most common is the mandibular fracture; and the

Surgical mandibulo maxillary fixation (MMF) is a proven method of stabilizing most maxillofacial fractures involving the maxilla and/or mandible . Different surgical options available for treating maxillofacial fractures include open reduction internal fixation (ORIF), open reduction, closed reduction, and orbital reconstruction. Treatment outcomes usually rely on the nature of injury, type of fracture, expertise of surgeon, and devices/technology used . Infection is the most commonly reported complication of surgical treatment. Other less common complications include malunion of fractures, malocclusion, and temporomandibular joint disorder .

Closed reduction and nonrigid fixation is the traditional treatment option based on surgical method; however, the most common method of treatment is ORIF . Fractures with a deviation of 10° to 45° or a ≥2 mm shortening of ascending ramus, should be treated with ORIF, irrespective of level of the fracture . ORIF provides a shortened period of MMF, bony union with minimal callus formation, and rapid recovery of normal jaw functions .

Currently used

MMF using circumdental wires and arch bars may often result in partial or absent dentition. Lengthy operative time, risk for glove puncture, and pain during removal are other drawbacks of these traditional techniques . On the other hand, MMF screws are easy to use, may cause fewer traumas, may pose lower risk for percutaneous and mucosal wire punctures, and reduce risk of needle-stick injury . Understanding the biomechanical demands related to their use, proper modifications in design and customized placement to reduce any potential morbidity, and image-guided preoperative planning would make the use of MMF screws more advantageous. MMF screws can represent as a viable alternative to fixation with arch bars. It offers reduced costs as there is a decreased need for secondary procedures . Iatrogenic injury to dental roots, one of the risks involved with MMF screws, can be reduced by an experienced surgeon . These screws also help in maintaining better oral hygiene than arch bars and produces acceptable malocclusion