Treatment outcomes with the use of maxillomandibular fixation screws in the management of mandible fractures.
OBJECTIVE
The purpose of this prospective randomized study was to assess whether uncomplicated mandible fractures could be treated successfully in an open or closed fashion using maxillomandibular fixation (MMF) screws.


METHODS
This was a prospective institutional review board-approved study involving 20 adult patients who presented to the university emergency department or oral and maxillofacial surgical clinic with uncomplicated mandible fractures. Patients who met the exclusion criteria consented to enter the study in the open reduction internal fixation (ORIF) or the closed (MMF) study group. Six to 8 MMF screws were used to obtain intermaxillary fixation (IMF) in the 2 groups. Screw failure was documented. All screws were removed at 5 to 6 weeks postoperatively. Insertional torque (IT) was measured at time of screw placement to assess primary stability. Clinical and photographic documentation was performed to assess fracture healing, occlusion, and gingival health. Ten-centimeter visual analog scales were used to assess patient-centered outcomes. Cone-beam computed tomography was performed to assess the long-term effects on the periodontium and roots. A cost comparison was performed to determine whether the use of screws was cost effective compared with arch bars.


RESULTS
Fifteen men and 5 women (mean age, 25.2 yr) entered the study. All patients displayed adequate fracture healing based on clinical examination. All patients had acceptable occlusion at 5 to 6 weeks postoperatively. Total screw failure was 27 of 106 screws (25.5%). Forty percent of screws placed in the MMF group failed compared with only 6% in the ORIF group. Gingival health scores were favorable. Factors that had a significant effect on screw failure included a lower IT (P = .002), use in closed (MMF) treatment (P < .001), and use in the posterior jaw (P = .012). Minimal pain was associated with the MMF screws and pre-existing occlusion was re-established based on patients' subjective responses. The MMF group reported a statistically significant lower quality of life (P < .001) compared with the ORIF group. There was only 1 screw site that had a facial cortical bone defect noted at 6-month follow-up CBCT examination. There were no discernible long-term root defects. Cost analysis showed that the use of MMF screws saved around $600 per patient in operating room usage cost alone compared with the estimated use of arch bars.


CONCLUSIONS
Uncomplicated mandible fractures were successfully treated using MMF screws in open and closed treatments. However, the utility in closed treatment was decreased because of significant screw failure and patient noncompliance. The screws were well tolerated by the patients. There was minimal long-term damage to the periodontium and dental roots. The cost of screws was more than offset by time savings.
Resident, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS.
Griffin Harold
GH
West
Professor, Department of Biomedical Materials Science, University of Mississippi Medical Center, Jackson, MS.
Jason Alan
JA
Griggs
Assistant Professor, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS.
Ravi
R
Chandran
Professor Emeritus, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS.
Harry Vincent
HV
Precheur
Professor, Department of Periodontics and Preventive Sciences, University of Mississippi Medical Center, Jackson, MS.
William
W
Buchanan
Associate Professor, Interim Chairman and Program Director, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS. Electronic address: rcaloss@umc.edu.
Ron
R
Caloss
D000203:Activities of Daily Living; D000328:Adult; D000539:Alveolar Process / Q000000981:diagnostic imaging; D001863:Bone Screws / Q000191:economics; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003362:Cost-Benefit Analysis; D003768:Dental Occlusion, Centric; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000191:economics / Q000295:instrumentation; D017102:Fracture Healing / Q000502:physiology; D005881:Gingiva / Q000473:pathology; D005891:Gingivitis / Q000209:etiology; D006801:Humans; D019248:Jaw Fixation Techniques / Q000191:economics / Q000295:instrumentation*; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology; D023861:Photography, Dental; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D014092:Tooth Root / Q000000981:diagnostic imaging; D019415:Torque; D016896:Treatment Outcome