Interim fixation of mandible fractures.

The mandible provides structural support for the teeth and a route for neural and vascular supply to the dentition, as well as sensory perception for the lower one-third of the face. Although the mandible is the largest and strongest facial bone, fractures frequently result as a sequela of facial trauma because of the mandible’s physical prominence in the lower face. Vehicular accidents and assaults are the leading causes of mandibular fractures.1–3 Open reduction and internal fixation are often the treatment of choice for significantly displaced mandible fractures.4 Yet reduction of these displaced bony fragments, and their subsequent stabilization during plating, can be difficult and occasionally cumbersome, involving several instruments and multiple hands in a small operative field. Thus, reduction and plating techniques for open repair of mandible fractures often require two surgeons or at least one surgeon and a skilled technician. To lessen the technical assistance needed and to assist with reduction prior to plating, several methods have been proposed in the literature. These involve the use of towel clamps, screws, and wires.5 However, in theory, these are not completely optimal. With towel clamp and modified towel clamp techniques, the surgeon is still required to manipulate large clamps while drilling and plating.5 One must also remember that a large clamp remains in the operative field, possibly compromising direct visualization, especially when operating through a small incision. The screw-wire osteosynthesis technique described by Dym and coworkers was used on more than 40 unfavourable mandible angle fractures as the sole source of repair.6 This technique uses 8-mm screws and 24-gauge wire at the angle of the mandible. Dym and colleagues reported no complications for their small cohort.6 This brief article outlines an approach to the interim fixation of the fractured mandible prior to definitive plating. This technique provides the surgeon with the opportunity to use both hands during placement of plates and the additional comfort of having fewer instruments in the area of interest during plating. In addition, this technique provides for increased stability of fracture fixation, serving as a useful tension band because the interim stabilization device is not removed after plating. This procedure also decreases the probability of incorrectly placed plate holes because it permits reduction prior to plating in a manner that allows simultaneous evaluation of both the occlusion and the fracture line.