title: Leonard buttons: a reliable method of intraoperative intermaxillary fixation in bilateral mandibular fractures.
abstract: OBJECTIVE
  To retrospectively audit outcomes of using Leonard buttons (LBs) as intraoperative intermaxillary fixation in conjunction with open reduction-internal fixation of bilateral mandibular fractures.
  
  
  METHODS
  Seventy-seven patients were included in this study. The fracture reduction score was obtained from postoperative radiographs by use of 3-tiered scoring system. Medical case notes were obtained for clinicodemographic data, including operation length, postoperative occlusion scores, periodontal status, and complications.
  
  
  RESULTS
  The cohort predominantly comprised male patients (87%), with a mean age of 26 years. The major cause of injury was interpersonal violence (87%). The fracture pattern most treated was angle-parasymphysis fracture (70.1%). The mean length of follow-up was 83.81 ± 79.33 days. The mean overall reduction score was 6.95 ± 1.03 in the LB group and 6.40 ± 1.68 in the arch bar (AB) group (P = .275). When the occlusion scores were evaluated, the difference between the 2 groups was statistically significant (P = .027). The mean operation length was shorter in the LB group compared with the AB group (142.05 ± 32.31 minutes vs 161.00 ± 24.04 minutes, P = .013). Oral hygiene was poor in 7 patients in the LB group (11.3%) and in 5 patients in the AB group (33.3%) (P = .05). No significant correlation was observed between number of LBs placed with overall reduction and occlusion scores. No significant relation was observed for number of LBs and periodontal status, infection, and nonunion.
  
  
  CONCLUSIONS
  This pilot study suggests that LBs are able to achieve equally good reduction as ABs but have better occlusion scores, with a shorter operating time, and show better gingival health. LBs are a viable alternative to ABs in providing intraoperative intermaxillary fixation for bilateral mandibular fractures. However, further prospective, randomized studies should be undertaken to obtain conclusive evidence.
authors.affiliation: Maxillofacial Unit, Guy's, King's & St Thomas' Dental Institute, King's College Hospital, London, England. naseemghazali@doctors.org.uk
authors.forename: Naseem
authors.initials: N
authors.lastname: Ghazali
authors.forename: M Emre
authors.initials: ME
authors.lastname: Benlidayi
authors.forename: Neilufer
authors.initials: N
authors.lastname: Abizadeh
authors.forename: Robert P
authors.initials: RP
authors.lastname: Bentley
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D019230:Dental Audit; D003766:Dental Occlusion; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D007430:Intraoperative Care; D019248:Jaw Fixation Techniques / Q000295:instrumentation*; D008297:Male; D008337:Mandibular Fractures / Q000145:classification / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D009910:Oral Hygiene; D009984:Orthopedic Fixation Devices; D010512:Periodontal Index; D010865:Pilot Projects; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014754:Violence / Q000706:statistics & numerical data; D055815:Young Adult