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British Journal of Oral and Maxillofacial Surgery 45 (2007) 679–680

Technical note
Maxillomandibular fixation with Otten mini-hooks
Panagiotis Koulocheris ∗ , Nikolaos Sakkas, Joerg-Elard Otten
Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University, Freiburg, Germany

Accepted 10 February 2007

Available online 17 July 2007

Keywords: Maxillomandibular fixation; Condylar fractures; Closed reduction

Closed reduction and maxillomandibular fixation (MMF) of
condylar fractures may be necessary in cases in which there
is minimal condylar displacement. Wired arch bars are often
used, but other types of fixation have been described, most
of which are complicated and expensive, and need more lab-
oratory support or extended operating time.1,2
Otten described a modified technique for MMF based on
an idea of Dal Pont’s about the two-points MMF.3 Otten’s
method is to bore two holes in the anterior nasal spine and in
the mental protuberance, then fix two hand-bent wire hooks
with osteosynthesis miniscrews (10–14 mm long). The hooks
are made of spring rate steel wire 0.8 mm thick and one end of
each hook is bent into an eyelet (Figs. 1 and 2). It is essential
to prepare the anterior nasal spine and the mental protuber-
ance with a minimal vertical incision under local anaesthesia.
The primary wound is closed with single sutures, and the
two metal hooks extend from the anterior upper and lower
jaws. These hooks act as abutments for intermaxillary elas-
tics (Fig. 3). At the end of treatment, the hooks and screws
can be removed under local anaesthetic.
We have used this technique for over 25 years in our
department. It is simple, quick, economical, and minimally
invasive. Typical indications for its use are non-dislocated
unilateral condylar fractures, particularly in children. We
leave the MMF for 7–10 days and occasionally for a further

Fig. 1. The wire hook and miniscrew (12 mm).

∗ Corresponding author at: Department of Oral and Maxillofacial Surgery,

University Hospital, Hugstetter Str. 55, D-79106 Freiburg, Germany.

Tel.: +49 761 270 4701; fax: +49 761 270 4877.
E-mail address: panagiotis.koulocheris@uniklinik-freiburg.de Fig. 2. Lateral cephalometric radiograph showing the miniscrews and the
(P. Koulocheris). wire hooks in situ.

0266-4356/$ – see front matter © 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2007.02.002
680 P. Koulocheris et al. / British Journal of Oral and Maxillofacial Surgery 45 (2007) 679–680
Fig. 3. Otten mini-hooks in place.
week with softer elastics, which allows a slight and early
movement of the mandible. The patient takes a liquid diet
during the MMF and stays in hospital for 2–3 days postop-
eratively. Patients are able to cut the elastics with scissors
in case of emergency (for example, vomiting, difficulty in
breathing, or a panic attack).
Complications might be injury to teeth or a haematoma
on the floor of the mouth during or after drilling. To pre-
vent the overloading of the anterior teeth and a possible
diastema during the MMF, we suggest the use of a bite guard
splint.
References
1. Honig JF. The Gottingen quick arch-bar. A new technique of arch-
bar fixation without ligature wires. J Craniomaxillofac Surg 1991;19:
366–8.
2. Terai H, Shimahara M. Closed treatment of condylar fractures by inter-
maxillary fixation with thermoforming plates. Br J Oral Maxillofac Surg
2004;42:61–3.
3. Otten JE. Modifizierte methode zur intermaxillären immobilisation
[Modified methods for intermaxillary immobilization]. Dtsch Zahnarztl
Z 1981;36:91–2.