Application of intermaxillary fixation screws in maxillofacial trauma.
OBJECTIVE
The use of intermaxillary fixation (IMF) in the treatment of maxillofacial trauma represents the cornerstone of fracture reduction and immobilization. Many modalities of IMF have been described; recently IMF screws have been introduced into clinical practice, however, hardware failure can occur. We performed a retrospective study evaluating hardware-associated complications for self-drilling/tapping IMF screws.


METHODS
A retrospective study on 49 patients requiring IMF was performed. The diagnosis, duration of IMF, screw site, use of elastic or wire fixation, and associated complications were recorded. IMF screws were used to adjunct open reduction techniques, for definitive closed reduction, or fracture prevention following dentoalveolar surgery. Follow-up examinations were performed until fracture healing was complete (6 to 8 weeks).


RESULTS
A single adverse event occurred in 19 patients (39%) while 4 patients (8%) had more than 1 complication. The most common event was screw loosening; 29% of patients had at least 1 screw dislodged in the treatment period. Of the total number of screws placed (229), 15 (6.5%) became loose, and were equally distributed among the mandible and maxilla. The remaining complications noted were root fracture, 4% (2 of 49); loosened wires, 6% (3 of 49); screw shear, 2% (1 of 49); malocclusion, 2% (1 of 49); and ingested hardware, 2% (1 of 49).


CONCLUSIONS
Overall the IMF self-drilling/tapping screws have been shown to be a useful modality to establish maxillomandibular fixation. It is a safe, and time-sparing technique; however, it is not without limitations or potential consequences which the surgeon must be aware of in order to provide safe and effective treatment.
Coletti
Domenick P
DP
Department of Oral and Maxillofacial Surgery, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Unit, Baltimore College of Dental Surgery, Baltimore, MD 21201, USA. dcoletti@umm.edu
Salama
Andrew
A
Caccamese
John F
JF
D001863:Bone Screws; D016009:Chi-Square Distribution; D004868:Equipment Failure; D005260:Female; D005547:Foreign Bodies / Q000209:etiology; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D019248:Jaw Fixation Techniques / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008446:Maxillofacial Injuries / Q000601:surgery*; D012189:Retrospective Studies; D012887:Skull Fractures / Q000601:surgery*; D013270:Stomach; D014092:Tooth Root / Q000293:injuries