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Intermaxillary Fixation with a Single Wire

Article  in  Journal of Maxillofacial and Oral Surgery · June 2016

DOI: 10.1007/s12663-016-0922-6

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Anshul J Rai Manal M Khan

AIIMS Bhopal All India Institute of Medical Sciences AIIMS Bhopal All India Institute of Medical Sciences
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ArticleTitle Intermaxillary Fixation with a Single Wire
Article Sub-Title
Article CopyRight The Association of Oral and Maxillofacial Surgeons of India
(This will be the copyright line in the final PDF)
Journal Name Journal of Maxillofacial and Oral Surgery
Corresponding Author Family Name Rai
Particle
Given Name Anshul
Suffix
Division Department of Trauma and Emergency Medicine
Organization AIIMS
Address Saket Nagar, Bhopal, M.P., India
Email anshul.dentalsurgery@aiimsbhopal.edu.in
ORCID

Author Family Name Khan

Particle
Given Name Manal M.
Suffix
Division Department of Plastic Surgery
Organization AIIMS
Address Saket Nagar, Bhopal, M.P., India
Email
ORCID

Received 13 September 2015

Schedule Revised
Accepted 21 May 2016
Abstract Intermaxillary fixation (IMF) is required before plating to achieve premorbid relationship of mandibular
and maxillary teeth. We recommended the use of single wire for achieving IMF using 24 gauze stainless
steel wire, which is easy, fast, economical and minimally invasive technique.
Footnote Information
 J. Maxillofac. Oral Surg.
DOI 10.1007/s12663-016-0922-6

1 TECHNICAL NOTE

2 Intermaxillary Fixation with a Single Wire

3 Anshul Rai1 • Manal M. Khan2

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Author Proof

4 Received: 13 September 2015 / Accepted: 21 May 2016

5 Ó The Association of Oral and Maxillofacial Surgeons of India 2016

PR
6AQ1 Abstract Intermaxillary fixation (IMF) is required before again to bring out on palatal side, it is then curved around 28
7 plating to achieve premorbid relationship of mandibular the cervical margin of central incisors teeth and brings out 29
8 and maxillary teeth. We recommended the use of single on buccal aspect. 30
9 wire for achieving IMF using 24 gauze stainless steel wire, The same wire was then curved around the buccal sur- 31
10 which is easy, fast, economical and minimally invasive face of lateral incisor and canine teeth and from the inter- 32
11AQ2 technique.
ED dental space, again brought out on palatal side (Fig. 3). 33
12 The wire ends were then inserted from the lingual side 34
of the mandible between canine and first premolar, so that 35
13 Intermaxillary fixation (IMF) with the help of IMF screws, both the ends were brought out buccally (Fig. 4). To avoid 36
14 arch bars, eyelet wiring, direct interdental wiring [1], mucosal impingement, the wire from one side was curved 37
15 buccolingual stabilization [2] and loop-designed wire [3] around the canine, lateral and central incisor brought lin- 38
CT

16 were commonly used. All these techniques are time con- gually. Then the same wire again from the other side lateral 39
17 suming and require expertise. We recommended the use of incisor inter-dental space brought buccally and tied to 40
18 single 24 gauze wire for achieving IMF (Fig. 1). In cases achieve IMF (Fig. 2). 41
19 where wire was impinging on the mucosa, the wire was
20 curved around the cervical margins of the teeth interden-
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21 tally to achieve IMF (Fig. 2). Advantages of IMF with single wire 42
RR

1. Easy and simple. 43

22 Technique 2. Quick. 44
3. Less expensive. 45
23 A 24 gauze wire is used after stretching 10 % from its 4. Easy to maintain oral hygiene. 46
24 original length. The wire was inserted from palatal side 5. Painless procedure. 47
25 between canine and first premolar from one side, then 6. Less chance of percutaneous injury to fingers. 48
CO

26 taken out on buccal side curved around the canine and 7. Excellent technique for intra operative and short-term 49
27 lateral incisor and then inserted into the inter-dental space IMF. 50
8. Required less armamentarium. 51
9. Can be used in non-displaced or minimally displaced 52
A1 & Anshul Rai fracture for closed reduction. 53
UN

A2 anshul.dentalsurgery@aiimsbhopal.edu.in;
A3 anshulrai007@yahoo.co.in
1
A4 Department of Trauma and Emergency Medicine, AIIMS, Disadvantages 54
A5 Saket Nagar, Bhopal, M.P., India
2
A6 Department of Plastic Surgery, AIIMS, Saket Nagar, Bhopal, 1. Cannot be used in partially edentulous patients. 55
A7 M.P., India

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 J. Maxillofac. Oral Surg.

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Author Proof

Fig. 3 Photograph represents wires placed in the maxillary arch

Fig. 1 Model showing IMF with a single wire

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ED
CT

Fig. 4 Photograph represents wires inserted from lingual side of

mandible
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Fig. 2 Photograph showing wires placed on the cervical margins of 4. Can be used in orthognathic and in tumor resection 65
RR

the teeth to achieve IMF surgeries. 66

5. In patients with myofacial pain dysfunction syndrome 67
who required short term IMF. 68
56 2. Proper inter-dental space is mandatory. 6. Can be used in mass casualties such as war injuries or 69
57 3. Long term stability is questionable. natural calamities for quick IMF. 70
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58 Indications Contraindications 71

59 1. In management of nondisplaced and favourable frac- 1. In panfacial fractures. 72

UN

60 tures of maxillofacial region. 2. In unfavourable, displaced fractures of maxillofacial 73

61 2. Intra-operative IMF for open reduction and internal region. 74
62 fixation. 3. Patients who requires long term IMF. 75
63 3. Closed reduction of non-displaced coronoid process, 4. Patients who required pre/post IMF elastic traction. 76
64 Lefort I fractures. 5. In partially edentulous patients. 77

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 J. Maxillofac. Oral Surg.

78 Discussion the older techniques only after they have been extensively 102
studied in multicentric studies with large sample size. 103
104
79 The aim of this technical note was to introduce a new and
Compliance with Ethical Standards 105
80 quick method of achieving IMF with fewer complications.
81 IMF screws and arch bars are commonly used for IMF, but Conflict of interest None. 106
82 they are time consuming, and screws can cause damage to
83 roots of the teeth [4], IMF with arch bars required multiple
84 wires which can cause damage to the fingers of the operator References 107
85 and also oral hygiene is difficult to maintain [5]. Direct

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86 interdental wiring again required multiple wires and it is 1. Rai A, Datarkar A, Borle RM (2011) Are maxillomandibular 108
fixation screws a better option than Erich arch bars in achieving 109
87 time consuming [6]. In buccolingual stabilization, wires 110
maxillomandibular fixation? A randomized clinical study. J Oral

OO
88 used on both the sides of the arch and two wires are Maxillofac Surg 69:3015–3018 111
89 required and if one breaks, we have open both the wires 2. Pappachan B (2010) Intermaxillary fixation with buccolingual 112
90 and again have to do IMF [2]. IMF by loop-designed wire stabilization. J Maxillofac Oral Surg 9:159–161 113
Author Proof

3. Verma A, Yadav S, Dhupar V (2015) A new simplified technique 114

91 four loops were made [3] and can irritate the tongue and 115
for intermaxillary fixation by loop-designed wire. J Maxillofac
92 sometimes cause ulceration and again technique sensitive. Oral Surg 14:499–500 116
93 Use of single wire for IMF eliminates all these 4. Cornelius PC et al (2010) The use of MMF screws: surgical 117

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94 complications. technique, indications, contraindications, and common problems in 118
review of the literature. Craniomaxillofac Trauma Reconstr 119
95 The single wire on the other hand, cannot be used in 120
3:55–80
96 panfacial and severely displaced fracture management. The 5. Arthur G, Berardo N (1989) A simplified technique of maxillo- 121
97 nondisplaced and favourable fracture of dentate segment mandibular fixation. J Oral Maxillofac Surg 47:1234 122
98 can be managed by single wire IMF. However, long term 6. Rai A, Datarkar A, Borle RM (2012) Comparative assessment 123
between eyelet wiring and direct interdental wiring for achieving 124
99 IMF with a single wire is questionable. The IMF with arch 125
intermaxillary fixation: a prospective randomized clinical study.
100 bars is the first choice when long term (more than 6 weeks)
ED J Oral Maxillofac Surg 70:1914–1917 126
101 IMF is required [1]. The present new technique can replace
E CT
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 Journal : 12663
Article : 922 123
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