title: Maxillomandibular Fixation by Plastic Surgeons: Cost Analysis and Utilization of Resources.
abstract: OBJECTIVE
  Maxillomandibular fixation (MMF) can be performed using various techniques. Two common approaches used are arch bars and bone screws. Arch bars are the gold standard and inexpensive, but often require increased procedure time. Bone screws with wire fixation is a popular alternative, but more expensive than arch bars. The differences in costs of care, complications, and operative times between these 2 techniques are analyzed.
  
  
  METHODS
  A chart review was conducted on patients treated over the last 12 years at our institution. Forty-four patients with CPT code 21453 (closed reduction of mandible fracture with interdental fixation) with an isolated mandible fracture were used in our data collection. The operating room (OR) costs, procedure duration, and complications for these patients were analyzed.
  
  
  RESULTS
  Operative times were significantly shorter for patients treated with bone screws (P < 0.002). The costs for one trip to the OR for either method of fixation did not show any significant differences (P < 0.840). More patients with arch bar fixation (62%) required a second trip to the OR for removal in comparison to those with screw fixation (31%) (P < 0.068). This additional trip to the OR added significant cost. There were no differences in patient complications between these 2 fixation techniques.
  
  
  CONCLUSIONS
  The MMF with bone screws represents an attractive alternative to fixation with arch bars in appropriate scenarios. Screw fixation offers reduced costs, fewer trips to the OR, and decreased operative duration without a difference in complications. Cost savings were noted most significantly in a decreased need for secondary procedures in patients who were treated with MMF screws. Screw fixation offers potential for reducing the costs of care in treating patients with minimally displaced or favorable mandible fractures.
authors.affiliation: From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Farber
authors.forename: Alison K
authors.initials: AK
authors.lastname: Snyder-Warwick
authors.forename: Gary B
authors.initials: GB
authors.lastname: Skolnick
authors.forename: Albert S
authors.initials: AS
authors.lastname: Woo
authors.forename: Kamlesh B
authors.initials: KB
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws / Q000191:economics*; D001864:Bone Wires / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D019248:Jaw Fixation Techniques / Q000191:economics* / Q000295:instrumentation; D008297:Male; D008334:Mandible / Q000601:surgery*; D008337:Mandibular Fractures / Q000191:economics / Q000601:surgery*; D008875:Middle Aged; D008923:Missouri; D061646:Operative Time; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013518:Surgery, Plastic / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult