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Comparison of hybrid arch bar versus conventional arch bar for temporary maxillomandibular fixation during treatment of jaw fractures: a prospective comparative study

  • Received : 2023.07.29
  • Accepted : 2023.10.28
  • Published : 2023.12.31

Abstract

Objectives: This study aimed to compare the effectiveness of a hybrid arch bar (hAB) with the conventional Erich arch bar (EAB) for the management of jaw fractures, focusing on their use for temporary fixation in patients undergoing open reduction and internal fixation (ORIF). Materials and Methods: Patients presenting with maxillary and mandibular fractures at our institution were included in this prospective, comparative study. Placement time and ease of occlusal reproducibility were recorded intraoperatively for Group A (hAB patients) and Group B (EAB patients). The primary outcome was comparison of the postoperative stability of the two arch bars. Postoperative measurements also included mucosal overgrowth, screw loosening or wire retightening, and replacement rates. The data were tabulated and computed with a P<0.05 considered statistically significant. Results: The study included 41 patients. A statistically significant difference was observed in postoperative stability scores (3) between Group A and Group B (85.0% vs 9.5%, P=0.001). The mean placement time in Group A (23.3 minutes) significantly differed from that in Group B (86.4 minutes) (P<0.001). The ease of intraoperative occlusion was not different between the two groups (P=0.413). Mucosal overgrowth was observed in 75.0% of patients (15 of 20) in Group A. Conclusion: The hAB was superior to EAB in clinical efficiency, maxillomandibular fixation time reduction, stability, versatility, and safety. Despite temporary mucosal overgrowth, the benefits of hAB outweigh the disadvantages. The choice between hAB and EAB should be based on specific clinical requirements.

Keywords

References

  1. Pandey S, Roychoudhury A, Bhutia O, Singhal M, Sagar S, Pandey RM. Study of the pattern of maxillofacial fractures seen at a tertiary care hospital in north India. J Maxillofac Oral Surg 2015;14:32-9. https://doi.org/10.1007/s12663-013-0578-4 
  2. Odono LT, Brady CM, Urata M. Mandible fractures. In: Dorafshar AH, Rodriguez ED, Manson PN, eds. Facial trauma surgery: from primary repair to reconstruction. Elsevier; 2020:168-85. 
  3. Rowe NL, Williams JL. Rowe and Williams՚ maxillofacial injuries. 2nd ed. Churchill Livingstone; 1994. 
  4. Morio W, Kendrick DE, Steed MB, Stein KM. The Omnimax MMF system: a cohort study for clinical evaluation. Preliminary results of an ongoing study. J Oral Maxillofac Surg 2018;76(10 Suppl):E79-80. https://doi.org/10.1016/j.joms.2018.06.166 
  5. Park KN, Oh SM, Lee CY, Kim JY, Yang BE. Design and application of hybrid maxillomandibular fixation for facial bone fractures. J Craniofac Surg 2013;24:1801-5. https://doi.org/10.1097/scs.0b013e3182a21163 
  6. West GH, Griggs JA, Chandran R, Precheur HV, Buchanan W, Caloss R. Treatment outcomes with the use of maxillomandibular fixation screws in the management of mandible fractures. J Oral Maxillofac Surg 2014;72:112-20. https://doi.org/10.1016/j.joms.2013.08.001 
  7. Hashemi HM, Parhiz A. Complications using intermaxillary fixation screws. J Oral Maxillofac Surg 2011;69:1411-4. https://doi.org/10.1016/j.joms.2010.05.070 
  8. Wilt D, Kim C, St. John D. Do hybrid arch bar screws pose a risk to the dentition? Oral Surg Oral Med Oral Pathol Oral Radiol 2019;128:E223-4. https://doi.org/10.1016/j.oooo.2019.07.018 
  9. Rai A, Datarkar A, Borle RM. Are maxillomandibular fixation screws a better option than Erich arch bars in achieving maxillomandibular fixation? A randomized clinical study. J Oral Maxillofac Surg 2011;69:3015-8. https://doi.org/10.1016/j.joms.2010.12.015 
  10. King BJ, Christensen BJ. Hybrid arch bars reduce placement time and glove perforations compared with Erich arch bars during the application of intermaxillary fixation: a randomized controlled trial. J Oral Maxillofac Surg 2019;77:1228.e1-8. https://doi.org/10.1016/j.joms.2019.01.030 
  11. Nandini GD, Balakrishna R, Rao J. Self tapping screws v/s Erich arch bar for inter maxillary fixation: a comparative clinical study in the treatment of mandibular fractures. J Maxillofac Oral Surg 2011;10:127-31. https://doi.org/10.1007/s12663-011-0191-3 
  12. Chao AH, Hulsen J. Bone-supported arch bars are associated with comparable outcomes to Erich arch bars in the treatment of mandibular fractures with intermaxillary fixation. J Oral Maxillofac Surg 2015;73:306-13. https://doi.org/10.1016/j.joms.2014.08.025 
  13. Roeder RA, Guo L, Lim AA. Is the SMARTLock hybrid maxillomandibular fixation system comparable to intermaxillary fixation screws in closed reduction of condylar fractures? Ann Plast Surg 2018;81(6S Suppl 1):S35-8. https://doi.org/10.1097/sap.0000000000001497 
  14. Pathak P, Thomas S, Bhargava D, Beena S. A prospective comparative clinical study on modified screw retained arch bar (SRAB) and conventional Erich՚s arch bar (CEAB). Oral Maxillofac Surg 2019;23:285-9. https://doi.org/10.1007/s10006-019-00766-1 
  15. Rothe TM, Kumar P, Shah N, Shah R, Mahajan A, Kumar A. Comparative evaluation of efficacy of conventional arch bar, intermaxillary fixation screws, and modified arch bar for intermaxillary fixation. J Maxillofac Oral Surg 2019;18:412-8. https://doi.org/10.1007/s12663-018-1110-7 
  16. van den Bergh B, Blankestijn J, van der Ploeg T, Tuinzing DB, Forouzanfar T. Conservative treatment of a mandibular condyle fracture: comparing intermaxillary fixation with screws or arch bar. A randomised clinical trial. J Craniomaxillofac Surg 2015;43:671-6. https://doi.org/10.1016/j.jcms.2015.03.010 
  17. Cornelius CP, Ehrenfeld M. The use of MMF screws: surgical technique, indications, contraindications, and common problems in review of the literature. Craniomaxillofac Trauma Reconstr 2010;3:55-80. https://doi.org/10.1055/s-0030-1254376 
  18. Kendrick DE, Park CM, Fa JM, Barber JS, Indresano AT. Stryker SMARTLock hybrid maxillomandibular fixation system: clinical application, complications, and radiographic findings. Plast Reconstr Surg 2016;137:142e-150e. https://doi.org/10.1097/prs.0000000000001920 
  19. Kiwanuka E, Iyengar R, Jehle CC, Mehrzad R, Kwan D. The use of Synthes MatrixWAVE bone anchored arch bars for closed treatment of multiple concurrent mandibular fractures. J Oral Biol Craniofac Res 2017;7:153-7. https://doi.org/10.1016/j.jobcr.2017.08.006 
  20. Bouloux GF. Does the use of hybrid arch bars for the treatment of mandibular fractures reduce the length of surgery? J Oral Maxillofac Surg 2018;76:2592-7. https://doi.org/10.1016/j.joms.2018.06.172 
  21. Khelemsky R, Powers D, Greenberg S, Suresh V, Silver EJ, Turner M. The hybrid arch bar is a cost-beneficial alternative in the open treatment of mandibular fractures. Craniomaxillofac Trauma Reconstr 2019;12:128-33. https://doi.org/10.1055/s-0038-1639351