Is the Erich arch bar the best intermaxillary fixation method in maxillofacial fractures? A systematic review

Study Design: Systematic review and meta-analysis. Objective: Maxillomandibular fixation (MMF) is a step of paramount importance during the management of maxillofacial trauma. Erich arch bars are being used for this purpose for decades but with advances in maxillofacial trauma management, intermaxillary fixation screws came into existence and are being used routinely. The present study was designed to identify if the intermaxillary fixation screws are really an alternative to Erich arch bars for management of maxillofacial trauma. Methodology: An exhaustive literature search was conducted in May 2020 on various electronic databases and studies comparing Erich arch bars and intermaxillary fixation screws were recruited for the analysis. Random-effects model with Mantel Haenszel statistics was used to analyze oral hygiene and duration of achieving MMF. Results: A total of 96 studies were identified, out of which 8 studies were included in the meta-analysis. There was no statistically significant difference in oral hygiene status of the patients in both the groups. Intermaxillary fixations screws required statistically significantly less time in achieving MMF. Needle stick injury was prominently seen with the use of Erich arch bar whereas other complications like mucosal coverage, root injury, screw loosening and screw fracture makes the use of intermaxillary fixation screws questionable. Conclusion: The present meta-analysis suggests that there is not enough evidence to recommend the use of intermaxillary fixation screws as an alternative to Erich arch bars. Further research with large sample size, high quality evidence and better methodology is recommended in this direction.

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Simple Modification in Wiring for Efficient Application of Arch Bar to Achieve Intermaxillary Fixation

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1723905 ◽

2021 ◽

Author(s):

Pawan Agarwal ◽

Rajeev Kukrele ◽

Dhananjaya Sharma

Keyword(s):

Intermaxillary Fixation ◽

Simple Modification ◽

Arch Bar

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The Use of Risdon Cables in Pediatric Maxillofacial Trauma: A Technique Revisited

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0032-1313362 ◽

2012 ◽

Vol 5 (2) ◽

pp. 107-109 ◽

Cited By ~ 2

Author(s):

Matthew Madsen ◽

Paul S. Tiwana ◽

Brian Alpert

Keyword(s):

Primary Teeth ◽

Maxillofacial Trauma ◽

Facial Skeleton ◽

Intermaxillary Fixation ◽

Pediatric Fractures ◽

Arch Bar ◽

Tooth Buds ◽

Future Growth

Although less common than adult fractures, fractures of the pediatric maxillofacial skeleton present unique challenges. Different considerations including variations of anatomy including tooth buds, dental variations, as well as considerations for future growth must be addressed. When traditional techniques to treat adult fractures are applied for securing intermaxillary fixation (IMF) such as arch bars, difficulty arises because the primary teeth are shorter and conventional arch bar techniques may slip off intra or postoperatively. We present a technique to achieve both IMF as well as interdental stability using a Risdon cable. Although this technique is not new, we present it as our preferred method for treating pediatric fractures of the facial skeleton where IMF must be accomplished.

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Assessment of Knowledge about Lefort I Fracture Among Dental Students

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl3.3012 ◽

2020 ◽

Vol 11 (SPL3) ◽

pp. 736-739

Author(s):

Pravinya ◽

Dhanraj Ganapathy ◽

Subhashree Rohinikumar

Keyword(s):

Traffic Accidents ◽

Clinical Presentation ◽

Cerebrospinal Fluid Leak ◽

Dental Students ◽

The Body ◽

Intermaxillary Fixation ◽

Custom Made ◽

Maxillofacial Fractures ◽

The Face ◽

Facial Area

Fractures of the middle third of the face have increased in number over the past two decades. Trauma to the facial area results in injuries not only to dental structures but also maxillomandibular fractures. In addition, these injuries frequently occur in combination with injuries of other parts of the body. The etiology of these fractures have various causes, such as traffic accidents, falls, assaults, sports, and others. The aim of the study was to assess the knowledge and awareness about LeFort I fracture among undergraduate dental students. A custom made questionnaire comprising of 10 questions to assess the knowledge about LeFort I fracture was formulated and circulated among 100 undergraduate dental students. The responses were then subjected to statistical analysis. Among 100 undergraduate dental students, 52% of them were aware of the types of maxillofacial fractures, and LeFort I fracture is a maxillary fracture, 34% of them have reported that Le Fort I fracture causes disruption of the cribriform plate of the ethmoid bone,35% of them reported that LeFort I fracture might be associated with cerebrospinal fluid leak and 25% of them were still unaware that floating palate is the typical clinical presentation of LeFort I fracture. Also, only 30% were aware that intermaxillary fixation is the management of LeFort I fracture. The present study suggests that among undergraduate dental students, the knowledge about the clinical presentation and the management of LeFort I fracture is inadequate.

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Conservative treatment of a mandibular condyle fracture: Comparing intermaxillary fixation with screws or arch bar. A randomised clinical trial

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2015.03.010 ◽

2015 ◽

Vol 43 (5) ◽

pp. 671-676 ◽

Cited By ~ 17

Author(s):

B. van den Bergh ◽

J. Blankestijn ◽

T. van der Ploeg ◽

D.B. Tuinzing ◽

T. Forouzanfar

Keyword(s):

Clinical Trial ◽

Conservative Treatment ◽

Mandibular Condyle ◽

Randomised Clinical Trial ◽

Intermaxillary Fixation ◽

Arch Bar ◽

Condyle Fracture ◽

With Screws

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Comparison of Erich arch bar versus embrasure wires for intraoperative intermaxillary fixation in mandibular fractures

Oral and Maxillofacial Surgery ◽

10.1007/s10006-018-0723-9 ◽

2018 ◽

Vol 22 (4) ◽

pp. 419-428

Author(s):

Ashish Shrikant Satpute ◽

Syed Ahmed Mohiuddin ◽

Amol Madhukar Doiphode ◽

Sujay Sanjay Kulkarni ◽

Ahtesham Ahmad Qureshi ◽

...

Keyword(s):

Mandibular Fractures ◽

Intermaxillary Fixation ◽

Arch Bar

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Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable?

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1603453 ◽

2018 ◽

Vol 11 (2) ◽

pp. 118-123

Author(s):

Sanjay Rastogi ◽

Tousif Ahmed ◽

Kolli Giri ◽

Ramakant Dandriyal ◽

Indra B. Niranjana Prasad ◽

...

Keyword(s):

Statistical Significance ◽

Demographic Data ◽

Study Data ◽

Mandibular Fractures ◽

Intermaxillary Fixation ◽

Maxillomandibular Fixation ◽

Arch Bar ◽

Significant Difference ◽

Group A ◽

Group B

The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t-test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 minutes) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B ( p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B ( p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar.

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TO COMPARE THE EFFECTIVENESS OF INTERMAXILLARY FIXATION USING ERICH ARCH BAR AND SCREWS IN MANDIBULAR FRACTURES – A RANDOMIZED CLINICAL STUDY.

10.36106/ijsr/6226154 ◽

2021 ◽

pp. 24-27

Author(s):

Ayeshwarya Chaudhary ◽

Aashish Deshmukh ◽

Manasi Bavaskar ◽

Mehul Bhoye ◽

Rajwardhan Shinde

Keyword(s):

Mandibular Fracture ◽

Mandibular Fractures ◽

Intermaxillary Fixation ◽

Glove Perforation ◽

Randomized Clinical Study ◽

Arch Bar ◽

Group A ◽

The Mean ◽

Group B ◽

Mean Time

Purpose: Intermaxillary xation (IMF) is an essential principle in the management of mandibular fractures; but with the recent advent of open reduction and internal xation (ORIF), the use of IMF is almost limited to intraoperative procedure only. This study aims to investigate and compare the effectiveness of Erich arch bar & intermaxillary xation (IMF) screws for the management of mandibular fractures. Materials And Method: A randomized prospective study was conducted on 20 patients with mandibular fracture, who were randomly allotted to two groups. Group A patients received intermaxillary xation using Erich arch bar and group B patients received IMF screws. The parameters assessed were time taken for application and removal of appliance, stability of occlusion, glove perforation, and pre-and post-operative plaque accumulation. Results: The mean time for placement of the Erich arch bar was 43.10 minutes as compared to 18.60 minutes with intermaxillary xation screws. Better occlusal stability was shown with an arch bar over IMF screws, and was statistically signicant. More glove tears or penetrations occurred during application in group A than Group B (p<0.01). Also, The Plaque Index assessment on removal of appliance showed a statistically signicant difference between the two groups; higher in the arch bar group. Conclusion: This study indicates that with acceptable occlusal stability, IMF screws technique is an effective and favourable alternative to Erich arch bars for temporary intermaxillary xation in mandibular fractures.

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