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Hazards of Using Guiding Elastics For Maxillo Mandibular Fixation MMF After Open Reduction and Internal Fixation Orif of Upper Mid Jcofs 1000107
Hazards of Using Guiding Elastics For Maxillo Mandibular Fixation MMF After Open Reduction and Internal Fixation Orif of Upper Mid Jcofs 1000107
Hazards of Using Guiding Elastics For Maxillo Mandibular Fixation MMF After Open Reduction and Internal Fixation Orif of Upper Mid Jcofs 1000107
Cosmetology &
gy c
Hegde et al., Cosmetol & Oro Facial Surg 2016, 2:3
Cosmetolo
ial
Surgery Oro Facial Surgery
Case Report Open Access
Abstract
In the view of current literature there is no need for Maxillo Mandibular Fixation (MMF) after Open Reduction
and Internal Fixation (ORIF) of midfacial fracture. But in order to achieve primary bone healing across fractured
segments many surgeons still put the patients on MMF postoperatively for a period of time depending on the
extent of fracture in order to achieve primary bone healing. There are various methods in the literature for MMF.
We present a case report of a patient undergoing MMF with arch bar and guiding elastics after ORIF of midfacial
fracture in order to achieve primary bone healing and the disadvantages we faced post operatively in relation to the
occlusion along with its management.
Keywords: Maxillo mandibular fixation (MMF); Open reduction palpation step deformity was elicited bilaterally over zygomatic region,
and internal fixation (ORIF); Lefort I fracture; Zygomatic complex right zygomatic arch region and right infraorbital rim. Tenderness was
fracture; Guiding elastics; Stainless steel wire present in right zygomatic arch and malar region (Figure 1).
Case Report *Corresponding author: Freddy Kersi Mistry, Post Graduate Department of Oral
and Maxillofacial Surgery, Mangalore, India, E-mail: drfreddymistry@gmail.com
A 50 years old male came with alleged history of RTA. He was Received April 19, 2015; Accepted August 02, 2016; Published August 06, 2016
admitted in local hospital where primary management was done and
Citation: Hegde NB, Hegde MN, Mistry FK, Gohil SM (2016) Hazards of Using
was referred to our hospital for further management. Guiding Elastics for Maxillo Mandibular Fixation (MMF) after Open Reduction and
Internal Fixation (ORIF) of Upper Mid Face Fracture: A Case Report. Cosmetol &
On extra-oral inspection, there was gross facial asymmetry, right Oro Facial Surg 2: 108.
periorbital edema and ecchymosis, right sub-conjunctival hemorrhage,
multiple abrasions noted over right zygomatic region, supraorbital, Copyright: © 2016 Hegde NB, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
temporal region reduced mouth opening and inability to open the right unrestricted use, distribution, and reproduction in any medium, provided the
eye completely although eye movements were normal in all gazes. On original author and source are credited.
Cosmetol & Oro Facial Surg, an open access journal Volume 2 • Issue 3 • 1000108
Citation: Hegde NB, Hegde MN, Mistry FK, Gohil SM (2016) Hazards of Using Guiding Elastics for Maxillo Mandibular Fixation (MMF) after Open
Reduction and Internal Fixation (ORIF) of Upper Mid Face Fracture: A Case Report. Cosmetol & Oro Facial Surg 2: 108.
Page 2 of 4
removed and patient was guided into proper occlusion and rigid MMF
was done with 26 Gauge Stainless Steel Wire (Figure 15).
After 1 month: There was no mobility of the maxillary segment
and proper occlusion was maintained.
Discussion
As a rule, early reduction of a Lefort I fractures presents minimal
Cosmetol & Oro Facial Surg, an open access journal Volume 2 • Issue 3 • 1000108
Citation: Hegde NB, Hegde MN, Mistry FK, Gohil SM (2016) Hazards of Using Guiding Elastics for Maxillo Mandibular Fixation (MMF) after Open
Reduction and Internal Fixation (ORIF) of Upper Mid Face Fracture: A Case Report. Cosmetol & Oro Facial Surg 2: 108.
Page 3 of 4
The fact that so many techniques are available for reduction and
fixation of zygomaticomaxillary complex (ZMC) fractures indicates
that no one technique is always superior to others. It is not so much
the actual technique, but the proper application of principles produces
satisfactory results. Each ZMC fractures should be treated aggressively
Figure 9: Right Fronto-zygomatic region fixed with one plate of 2 hole with gap.
Cosmetol & Oro Facial Surg, an open access journal Volume 2 • Issue 3 • 1000108
Citation: Hegde NB, Hegde MN, Mistry FK, Gohil SM (2016) Hazards of Using Guiding Elastics for Maxillo Mandibular Fixation (MMF) after Open
Reduction and Internal Fixation (ORIF) of Upper Mid Face Fracture: A Case Report. Cosmetol & Oro Facial Surg 2: 108.
Page 4 of 4
Figure 15: Guiding elastics removed and rigid MMF done with 26 gauge wire. 2. Banks P, Brown A (2001) Etiology, surgical anatomy and classification. In:
Banks P, Etiology, surgical anatomy and classification. In: Banks P,Brown A
(eds), Fractures of the facial skeleton. Philadelphia, USA, pp: 1-4.
with open reduction and internal fixation of at least two of its four 3. Shankar AN, Shankar VN, Hegde N, Sharma, Prasad R (2012) The pattern
major processes [6]. of the maxillofacial fractures e A multicentre retrospective study. Journal of
Cranio-Maxillo-Facial Surgery 40: 675-679.
In our case, since the Lefort 1 fracture line was undisplaced
4. World Health Organsisation (2014) Global Health Estimates.
there was no need for reduction and only fixation was done with
plates to improve the stability, as the zygomaticomaxillary complex 5. Fonseca RJ, Walker RV, Betts NJ, BarberHD, Powers MP (2005) Oral and
maxillofacial Trauma. (3rd edn.), Volume 2, Elseiver.
was comminuted conventional reduction was not possible and
anatomical reduction of the fragments was achieved by instrumental 6. Fonseca RJ, Walker RV, Betts NJ, BarberHD, Powers MP (2005) Oral and
maxillofacial Trauma. (3rd edn.), Volume 1, Elseiver.
manipulation with fixation at 3 points (frontozygomatic, infraorbital
and zygomaticomaxillary buttress region). 7. Mcginn JD, Fedok FG (2008) Techniques of maxillary-mandibular fixation.
Operative Techniques in Otolaryngology-Head and Neck Surgey 19: 117-112.
Cosmetol & Oro Facial Surg, an open access journal Volume 2 • Issue 3 • 1000108