1221424

review-article20242023
FACXXX10.1177/27325016231221424FACEAhmad et al.

Review

FACE

Fixation in Maxillofacial Surgery—Past,

1­–7
© The Author(s) 2024
DOI: 10.1177/27325016231221424
https://doi.org/10.1177/27325016231221424

Present and Future: A Narrative journals.sagepub.com/home/fac

Review Article

Wasim Ahmad1, Akash Ganguly1 , Ghulam Sarwar Hashmi1, Md

Kalim Ansari1, Tabishur Rahman1, and Mohammad Arman1

Abstract
Introduction:The present review explores the existing documentation in the literature related to the fixation of mandibular
fractures undertaken in maxillofacial surgery. Methods: English language articles were searched in various databases
such as Pubmed, Scopus, Science Direct and Google Scholar. The keyword used for searching are “Mandible Fracture,”
“Maxillomandibular fixation,” “Fixation” and “Recent Advancements.” Results about the history of fixation: Extended
history into the pre-Christian era, early medieval, through the 17th, 18th and 19th, 20th, 21st centuries have been dealt
in the narrative review. Emphasis on the present plating system with focus on present and future prospects like AI, virtual
reality as well as Magnesium based plating systems have also been dealt here. Conclusions: The present review spotlights
on understanding present, past, and future aspects of fixation of mandibular fractures. Currently, titanium plates are being
used and the most popular materials though future holds good prospects for polymer based and magnesium based materials.

Keywords
maxillomandibular fixation, internal fixation, mandible fracture, recent advancements

Introduction
History plays a crucial role in understanding the past and pre-
dicting the future, providing a foundation for the development
of new approaches and improving our understanding of cur-
rent procedures. This narrative review article explores the his-
tory of fracture treatment in maxillofacial surgery, highlighting
key advancements and notable contributions from ancient
civilizations to the modern era. Various databases like Pubmed,
Scopus, Science Direct and Google Scholar were utilized for
searching English language articles. Keywords used for
searching were “Mandible Fracture,” “Maxillomandibular
fixation,”“Fixation.” By tracing the evolution of fracture man-
agement techniques, we can gain valuable insights into the
development of current practices and appreciate the progress
made in craniofacial fracture treatment.
Past
The Pre-Christian Era
Hammurabi’s ancient law system, documented on clay tab-
lets, includes an early reference to fracture care in 5000 B.C.
The Edwin Smith papyrus, translated by Prof. Breasted,1 was
discovered in Egypt around 1600 B.C. and seems to be a
military surgeon’s work. It provides instructions for reducing
a dislocated mandible by placing the thumbs on the ends of
the mandible and using fingers under the chin to guide it
back into place. Simple jaw fractures were treated with ban-
dages soaked in honey and egg whites, while fresh meat was
applied to wounds on the first day. In ancient India, pedicle
flaps sourced from either the forehead or cheek were used to
repair defects concerning the nose or lips, as a means of pun-
ishment. Asklepios, renowned for his war wound care during
the Trojan Wars, became a symbol for the medical profes-
sion, represented by the Caduceus. Hippocrates, born in 460
B.C., introduced the concept of connecting loose teeth with a
gold or linen thread until the bone healed. Bandaging with
Carthaginian leather strips provided support for jaw frac-
tures. Hippocrates cautioned that incorrect bandaging could
cause harm despite its limited benefits for jaw fractures.
The Early Medieval Period
During the Roman Empire, there were no significant
advancements in the treatment of maxillofacial injuries, and
1
Aligarh Muslim University, Aligarh, Uttar Pradesh, India
Corresponding Author:
Akash Ganguly, Department of Oral and Maxillofacial Surgery, Dr.
Ziauddin Ahmad Dental College, Aligarh Muslim University, AMU
Campus, Medical Rd, Civil Lines, Aligarh, Uttar Pradesh 202001, India.
Email: akashganguly.dr@gmail.com
2 FACE 00(0)

physicians continued to rely on Hippocratic methods. In

1275, the first European Medical School was founded in
Salerno, Italy. Guglielmo Salicetti published detailed instruc-
tions on treating mandible fractures in his book Praxeos
Totius Medicinae. These instructions closely resembled
those of Hippocrates. Interestingly, Salicetti’s2 later work in
1492 introduced the concept of using the stable upper jaw’s
teeth to immobilize the lower jaw, a concept that was later
forgotten until its reintroduction by Gilmer in 1886. Gunshot
wounds during that time were believed to contain poisonous
substances, so they were treated with boiling oil and cautery,
often resulting in deformities. In 1572, Ambroise Paré, a sur-
geon from medieval Europe, endeavored to treat wounds
using soothing slaves.3 He suggested using pieces of cloth
placed on either side of the wound and stitching them
together, allowing the flesh to adhere and heal.

The 17th and 18th Centuries

We can find references to maxillofacial injuries during the
English Civil War and also by the early part of the 18th cen-
tury, a lot of progress was made in anatomical and physiolog-
ical knowledge. Pierre Fauchard’s book titled Traite de
Chirurgie Dentaire4 in 1728 paved the way for the develop-
ment of dental prostheses and techniques for controlling
fracture fragments using teeth ligation and bandages. In their
work “Traite des Maladies Chirurgicales” published in Paris
in 1779, Chopart and Desault introduced a splint made of
iron, resembling a shallow trough, which was inverted and
positioned over the occlusal surfaces of the lower teeth flank-
ing the fracture line. This device was secured firmly by
screws that manipulated rods connected to a submental plate
crafted from sheet iron, forming an intra-oral apparatus.5
Consequently, the compression between the occlusal teeth
surfaces and the lower mandibular border effectively hin-
dered any motion of the fragments. Variations of this princi-
ple were used in Germany, England, and Holland.
The 19th Century
The 19th century witnessed significant advancements in
fracture treatment techniques. Von Graefe’scranio-
maxillary suspension apparatus (Figure 1), introduced in
1823, revolutionized external suspension methods.6 In
1824, Ringelmann mentioned that Laudet(1812) had uti-
lized a wire passed through the alveolar bone to assist in
securing an upper denture.7 This technique is similar to the
current per-alveolar wiring method used for an edentulous
upper jaw. In 1840, Baudens presented a method for man-
aging oblique jaw fractures by running a wire around the
bone and wrapping it over a molar tooth.8 This technique
evolved into the modern circumferential wiring used to
keep a splint in place in an edentulous mandible.
Transosseous wiring using iron or silver wire was per-
formed by Buck, Kinloch, Annandale, and Cotton in the
Figure 1. Von Graefe’scranio-maxillary suspension apparatus.
GRAEFE, C. F. (1823) J. der Chir. u. Augenheilk. IV, 583-593.
mid-1800s.9-11 Hamilton in 1857 noticed that the traditional
4-tailed bandage could displace the fractured jaw fragment
posteriorly increasing the risk of respiratory obstruction.12
In 1866, Guerin made a discovery that trauma occurring
beneath the orbits not only leads to fractures in the maxil-
lary bones but the pyramidal portion of the palatine bone
and the pterygoid processes of the sphenoid bone are also
impacted. The presence of echymosis around the greater
palatine foramen can help in diagnosing low-level upper
jaw fractures.13 Before plastic surgery, facial and jaw inju-
ries were often treated by skilled metal craftsmen who cre-
ated intra-oral and extra-oral prostheses. Thomas Brian
Gunning developed a splint of vulcanized rubber in the
1800s.14 He used a monobloc splint for significant vertical
displacement, held in place by screws in both jaws.15
Gilmer rediscovered the technique of ligating individual
teeth with annealed soft copper wire to immobilize the
mandible. In 1907, Gilmer described the arch-bar method
of fixing, using a German silver wire that connected upper
and lower teeth.16 Angle introduced modified orthodontic
bands and threaded arch bars for controlling jaw fractures
in 1890.17 Rene le Fort’s studies in 1901 provided a com-
prehensive understanding of bone displacements and frac-
ture patterns in the facial skeleton.18 Fractures of the orbital
floor and zygomatic bone received attention from Lang,
Matas, Lothrop, and Keen in the late 1800s and early 1900s.
First and Second World War
The First Word War (1914-1918). Amid the First World War,
the stationary trench combat and high-speed projectiles
Ahmad et al.
resulted in a notable number of injuries to the maxillofacial
region. Major Gillies established a special center for these
injuries, promoting cooperation between plastic surgeons,
anesthetists, and dental surgeons. This period saw advance-
ments in dental treatment by Captain Kelsey Fry and the
invention of endotracheal anesthesia by Major Magill.
X-rays were discovered by Roentgen which assisted the sur-
geons in aligning bone fragments. The introduction of skin
grafting intraorally and the identification of the tube pedicle
by Gillies19 in 1917 marked the initiation of facial recon-
struction. Despite this, during that period, jaw splints were
fashioned as single units, and the fragments were adjusted
within the splint during the reduction process.20
The intervening years. During the interwar period between the
2 World Wars, notable progress was scarce. Notable excep-
tions included the introduction of the temporal approach for
treating depressed zygomatic bones and the innovation of
interdental eyelet wiring.
The Second World War (1939-1945). The Second World War
marked a turning point for maxillofacial surgery, with the
establishment of maxillofacial units at home and in the mili-
tary and the specialties of plastic surgery, anesthesia, and
dental surgery would have to co-operate with the neurosur-
geon and the ophthalmic surgeon. Significant progress
occurred in both intra-oral and extra-oral fixation methods,
bolstered by advancements in dental laboratory technology.
The introduction of the locking plate technique by Kelsey
Fry, Shepherd, McLeod, and Parfitt enabled personalized fit-
ting and precise alignment of jaw fragments, ensuring the
seamless continuity of the jaw structure. Other techniques,
such as extra-oral pin fixation and the Brenthurst clamp,
were also developed. In 1942, Adams21 brought forth the
idea of internal skeletal fixation by employing subcutaneous
suspension wires threaded through perforations drilled in
either the zygomatic process of the frontal bone, the inferior
orbital rim, or the zygomatic bone. This method was aimed
at providing support to either the maxilla or the mandible.
Development of fixation. The AO-ASIF guidelines underscore
the fundamental principles of rigid fixation, encompassing
actions such as reducing bony segments, stable fixation,
immobilization, safeguarding blood supply, and encouraging
early functionality.22 Titanium hardware remains the prevail-
ing choice, featuring a variety of plate and screw sizes and
shapes that cater to surgeons’ requirements. In scenarios
where surgical exposure might jeopardize blood supply or in
cases of contaminated wounds, temporary use of skeletal pin
external fixation might be employed.23 Before the advent of
contemporary internal fixation techniques, maxillomandibu-
lar fixation (MMF) or interdental fixation was extensively
employed. MMF compresses fractures at the alveolus, yet
there might still be a gap along the inferior border of the
mandible. MMF contributes to achieving anatomically
3
favorable configurations. Diverse hardware designs and
techniques are accessible for MMF, including arch bars, ivy
loops, and MMF screws. Utilizing arch bars for MMF pro-
vides the added advantage of creating a tension band at the
alveolar component of maxillomandibular fractures, aiding
in withstanding tensile forces near the teeth.
Rigid versus functionally stable fixation. The concept of rigid
versus functionally stable fixation was explored, with rigid
fixation aiming to prevent interfragmentary movement
between fracture segments. Non-rigid fixation techniques,
such as the one given by Champy for mandibular angle frac-
tures, allow for controlled interfragmentary motion during
healing.
At a histologic level, when rigid internal fixation is
employed with a minimum gap between bone segments, it
offers the advantage of facilitating primary bone healing
through haversian remodeling. In this process, osteoclasts
cross the fracture gap, followed by angiogenesis and the
deposition of osteoid by nearby osteoblasts. Over time, the
bone undergoes remodeling, resulting in the development of
mature haversian bone. The situation is different for fractures
that have a significant gap or interfragmentary movement
between the fragments, as they heal through secondary inten-
tion with the formation of an intermediate hematoma and
bone callus.
In 1978, Champy explained the application of a single
miniplate adapted to the superior border of fractures occur-
ring at the angle of the mandible. This approach has been
referred to as “functionally stable” since it permits mandibu-
lar movement during the healing process, even when there is
movement between the fractured segments.24
Compression plate osteosynthesis. Compression plating tech-
niques have found extensive application in maxillofacial sur-
gery for managing fractures of the mandible. The primary
objective of compression osteosynthesis, as outlined by AO,
is to attain complete stability along the fracture site, thereby
minimizing motion. This fosters an optimal setting for direct
bone healing by generating friction among compressed bone
segments and decreasing the gap between them.25 Dynamic
compression plates (DCPs) are specifically designed with
eccentric holes and inclined planes, generating interfragmen-
tal pressure through the “spherical gliding principle.” (Figure
2) The horizontal movement of screws in the plate holes
approximates the fracture surfaces and creates interfragmen-
tal pressure, promoting compression. However, compressive
plating techniques, including DCPs, require precise tech-
nique and are prone to operator error.
Noncompressionosteosynthesis. Noncompressionosteosynthe-
sis techniques, such as non-compression bone plates and
reconstruction plates with locking mechanisms, offer wider
uses and little room for error compared to compression
osteosynthesis.
4 FACE 00(0)
Figure 2. Spherical gliding principle (AO). Principles of
Internal Fixation of the Craniomaxillofacial Skeleton Trauma
and Orthognathic Surgery (Michael Ehrenfeld | Paul N Manson |
Joachim Prein).
Miniplates. Mini plates are commonly used in mandible frac-
ture fixation, with the Champy method being the most impor-
tant application. Monocortical fixation is preferred, but
bicortical fixation also has its applications. These miniature
plates are compatible with the identical screws used in con-
ventional mandibular fracture plates and frequently belong
to the category of locking plates. However, they are thinner
and more malleable compared to traditional plates. The
Champy method involves placing a mini plate at the zone of
tension, specifically the superior border, after reducing the
fracture. Care must be taken to avoid damaging dental struc-
tures. There may be events of screws becoming loose and
infectious complications concerning these miniplates due to
their reduced stability and strength in comparison with the
thicker hardware.
There are different types of mini plates available for man-
dibular and midfacial fixation. 2 mm system mandibular
mini plates are utilized in the mandible (Figure 3), and their
appropriate use is crucial for adequate stability. Midfacial
mini plates are available in various shapes and sizes with dif-
ferent screw options. Microplates are even smaller in size to
minimize visibility and palpability but still offer strength.
The selection of screws depends on their size, head design,
and self-tapping characteristics.
Mandibular reconstruction plates are longer and stronger
plates used for bridging defective areas of the mandible.
These load-bearing plates require at least 3 or 4 screws on
each side of the area of defect. Reconstruction plates for
mandible are available in different shapes and sizes, with
most using 2.7 mm screws. Some plates allow for compres-
sion or neutral screw placement.
Bioabsorbable plate fixation. The use of titanium implants in
surgery poses challenges such as biocompatibility and
Figure 3. Mandibular plates. a. 2.0 Compact Lock Plates (AO).
Principles of Internal Fixation of the Craniomaxillofacial Skeleton
Trauma and Orthognathic Surgery (Michael Ehrenfeld | Paul N
Manson | Joachim Prein).
susceptibility to infection. Metal implants do not undergo
remodeling like surrounding bone and can lead to the forma-
tion of a fibrous envelope that hampers immune cell migra-
tion and clearance of bacterial contamination. Bioabsorbable
fixation devices have emerged as a solution, eliminating the
need for the hardware to be removed and decreasing the
complications of prolonged retention. These implants have
been extensively studied in pediatric craniofacial surgery
and show advantages in preventing plate migration and
restricting bone growth. The most common bioabsorbable
materials are variations of polylactic acid and polyglycolic
acid polymers, with variations in resorption rates and han-
dling characteristics. While bioabsorbable hardware is not as
strong as titanium,25 it has demonstrated comparable out-
comes in terms of rates of infection, bone union, and other
complications. Proper case selection is crucial for successful
outcomes. Resorbable materials have lower tensile strength
compared to metallic systems, which affects their handling
during implantation. The manufacturing and sterilization
processes can also affect stability.
Lag Screws (Brons and Boering in 1970)
Lag screw osteosynthesis is an effective technique for frac-
ture compression, allowing for stable fixation without the
need for plate bending or multiple screws. This technique is
commonly used for mandibular fractures and provides excel-
lent stability and minimal complications26 when performed
correctly. In contrast to plate osteosynthesis, lag screw osteo-
synthesis involves directly passing through the fracture line,
evenly distributing compressive forces, and minimizing lin-
gual displacement.
Recent advancements in maxillofacial fixation. Recent advance-
ments in maxillofacial fixation have improved techniques for
managing complex fractures resulting from high-velocity
trauma. These advancements include enhancements in frac-
ture fixation and reduction techniques, as well as the applica-
tion of other surgical developments to trauma management.
Instances of these advancements encompass enhanced
Ahmad et al.
Figure 4. Intermaxillary fixation with the help of screws.
Textbook of Oral and Maxillofacial Surgery Fourth edition
(Neelima Anil Malik).
diagnostic imaging, minimally invasive surgical approaches,
endoscopic procedures, progress in biomaterials, real-time
imaging during surgery, rapid prototyping techniques, com-
puter-guided surgery, and customized implants.
Intermaxillary fixation screws. An enhancement involves the
utilization of intermaxillary fixation screws that incorporate
a gap beneath the screw head for wire passage. These screws
are positioned above the root tips in both the maxilla and
mandible, and wires are threaded through these openings to
bring the mouth into occlusion.27 These screws serve as tem-
porary fixation tools that can be taken out either during the
operation or at a subsequent time. They offer swift place-
ment, promote improved oral hygiene, and present a reduced
risk of injury compared to the use of arch bars and wires for
fixation (Figure 4)
Rapid intermaxillary fixation. Rapid IMF28 is a flexible plastic
band with adjustable properties that encircles a tooth, estab-
lishing a point of anchorage for temporary maxillomandibu-
lar fixation and immobilization. This technique reduces the
possibility of needle-stick injuries and can uphold intermax-
illary fixation for 3 weeks.
SonicWeld treatment. The SonicWeld Rx system is an
advancement that utilizes ultrasound vibration to insert a
completely resorbable SonicPin into a predrilled hole.29 The
SonicPin welds to the resorbable plate, creating a three-
dimensional stable construct. This system offers quick
implant insertion with minimal risk of stripping or shearing
compared to screw fixation. The SonicPin is made of the
same material as PDLLA implants and safely degrades
through hydrolysis and the metabolic process.
Self-drilling, self-tapping screws. Self-drilling, self-tapping
screws provide an advantage by eliminating the need to drill
5
Figure 5. Delta plate for fixation of condylar fracture. Textbook
of Oral and Maxillofacial Surgery Fourth edition (Neelima Anil
Malik).
a hole, thus reducing the osteosynthesis process and involv-
ing the use of fewer instruments. These screws exhibit simi-
lar pull-out strength to conventional self-tapping screws in
the bone which is thin and has superior retentiveness in can-
cellous bone due to their compressive action. Its use may be
limited in dense bone like mandible.30
Locking plates and screw system. Locking plates and screws
offer a mini internal fixator by locking the screw to the bone
as well as to the bone plate. This provides additional stability
and avoids cortical necrosis that can occur with compressive
plates.
3D plates. 3D plates provide tridimensional stability and can
be inserted through intraoral techniques. They have shown
low complication rates and offer an alternative to traditional
plates that depend on plate thickness for stability.
Trapezoidal condylar plates. Trapezoidal condylar plates ful-
fill biomechanical requirements for stable osteosynthesis in
the condylar region. These plates provide superior stability
compared to single-plating techniques and rectangular plates
in the sagittal plane.
Delta plate fixation for condylar fractures. The fixation system
known as the delta plate is specifically tailored for condylar
fractures. Its distinctive delta configuration is capable of
accommodating varying loads and can be conveniently posi-
tioned within the limited area of the condylar neck. Utilizing
an endoscopic-assisted transoral approach, fracture realign-
ment, and stabilization can be achieved with the delta-shaped
miniplate, circumventing noticeable scars on the face and
neck. These plates are made from pure titanium, measuring
1.3 mm in thickness, and are secured using 2.0 mm TriLock
titanium screws31 (see Figure 5).
Porous polyethylene implants. Porous polyethylene implants,
such as MEDPOR, have become popular for facial augmen-
tation, contour deformities correction, orbital floor repair,
and enophthalmos correction.32 These implants allow for
fibrovascular ingrowth, reducing the chances of extrusion
and rejection.
6 FACE 00(0)
The evolution of fixation systems has seen advancements
in dynamic compression plates, lag screws, bio-absorbable
plates, mini plates, and locking plates. Each type offers spe-
cific advantages and disadvantages in terms of compression,
cost, strength, and incidence of inflammatory complications.
Biomechanical principles of fixation. Biomechanical principles
play a crucial role in the development of fixation systems.
Understanding masticatory stress distribution in the mandi-
ble is essential for designing and positioning osteosynthesis
plates effectively. Considerations include re-establishment
of occlusion, anatomical reduction, stable fixation, and
maintenance of blood supply.
Future of fixation in maxillofacial surgery. The twentieth cen-
tury witnessed rapid discoveries and global dissemination of
knowledge. In the field of maxillofacial surgery, advance-
ments in histology/anatomy and biology/physiology have
laid the foundation for significant changes. Technological
progress, such as computer-based surgical navigation33 and
3D printing, has revolutionized surgical practices and paved
the way for robotic surgery. Engineering-assisted tissue
repair has also made great strides, enabling the development
of biomaterials and dental implants. Non-IMF reduction pro-
cedures and endoscopic techniques offer alternative
approaches to mandibular fracture therapy and facial fracture
treatment, respectively, with potential benefits such as faster
healing and reduced scarring. Biodegradable metals, particu-
larly Mg-, Zn-, and Fe-based materials, have diverse applica-
tions in oral and maxillofacial regions, promoting tissue
regeneration.34 Future research goals include exploring the
mechanical properties of biodegradable plates and screws,
investigating degradation mechanisms, developing new
materials like bone glues and staplers, and evaluating rapid
fixation procedures, require minimal equipment, and have
low morbidity and cost-effectiveness.
Future. Virtual reality (VR) and augmented reality (AR)
technologies are promising tools in maxillofacial surgery,
offering enhanced precision and safety. Mixed reality (MR)
allows for the replacement of physical cutting guides with
projected guidance lines directly onto the patient’s anatomy,
aiding surgeons in real-time visualization of patient-specific
cutting lines and interactive feedback. Recent studies dem-
onstrate MR’s potential in various craniomaxillofacial sur-
geries. In contrast, AR overlays MRI or CT data onto the
patient’s body during surgery, providing detailed insights
into internal structures, which can help with precise incisions
and visualizing critical anatomical features.35 Ackermann
et al introduced an AR application utilizing Microsoft Holo-
Lens to aid pelvic osteotomy and fragment reorientation,
enhancing visualization of the osteotomy cutting planes with
marker-equipped mounts.36 While AR and MR offer substan-
tial benefits, they also face limitations, including tracking
issues and hardware challenges. Further research is required
to refine these technologies and overcome their associated
limitations.
Artificial intelligence (AI) is the ability of intelligent
machines to predict unknown variables by using algorithms
and internal statistical patterns and information structures.
The working areas of AI in maxillofacial and plastic sur-
gery are wide and in the fields of rhinoplasty, orthognathic
surgery, cleft lip and palate, augmentation in implants, and
diagnosis and determination of survival rate in cancer patients.
Data-driven algorithms can be built by machines, and
thus, they can solve prediction problems without human
intervention. Several AI applications in maxillofacial sur-
gery utilize digital imaging, 3D photography, intraoral scans,
and 3D photographs to predict results and plan surgeries, for
example, after skeletal trauma.37-39
Future Materials That Can be Used for
Maxillofacial Surgery
Magnesium-based materials are gaining attention in maxillo-
facial surgery as a promising alternative to traditional titanium
plates and screws due to their comparable physical properties.
These materials address the limitations of synthetic polymeric
plates, offering resorbable options and enhanced biocompati-
bility. Research, including animal studies, has been actively
conducted to assess magnesium’s suitability in osteofixation
for facial fractures. Studies explore corrosion resistance and
potential surface modifications to improve biocompatibility.
Notable experiments with hydroxyapatite-coated magnesium
plates and promising results in beagle dog cases highlight the
potential benefits of magnesium-based solutions. While mag-
nesium-based headless screws applied to the fractures of the
condylar head in human cases exhibit excellent biocompatibil-
ity and comparable results to titanium,40 further clinical stud-
ies are needed to assess their viability for broader use in
maxillofacial surgery.
Conclusion
In conclusion, this narrative review provides a comprehen-
sive overview of the historical development of fracture treat-
ment in maxillofacial surgery. From ancient civilizations to
the modern era, various techniques and approaches have been
utilized to improve patient outcomes and restore normal func-
tion. The understanding of bone healing, advancements in
reduction and internal fixation techniques, and interdisciplin-
ary collaboration have significantly contributed to the prog-
ress in craniofacial fracture treatment. Overall, the article
provides an overview of the historical advancements in max-
illofacial fixation systems and highlights the current
approaches used in the 21st century. By reflecting on the past,
we can better appreciate the advancements made and pave the
way for future innovations in fracture care. The further
advancement of polymer-based materials should prioritize
enhancements in their mechanical strength, minimization of
Ahmad et al.
foreign-body responses, the ability to regulate the rate at
which they are absorbed by the body, and improved ease of
use in procedures like plate bending and self-tapping.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
Ethical Approval
Institutional Review Board approval was not required.
ORCID iD
Akash Ganguly https://orcid.org/0000-0002-8724-0175
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