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Cortical Bone Screws for Maxillomandibular Fixation in Orthognathic Surgery

Department of Oral & Maxillofacial Surgery, Pinderfields General Hospital, Wakefield, U.K.

Mr L. G. Thota, Oral & Maxillofacial Surgery, Pinderfields General Hospital, Wakefield WF1 4AL, U.K.

Introduction

Handicapping malocclusions can be managed by combined orthodontic and surgical treatment. Orthognathic surgery requires temporary intermaxillary fixation (IMF) to achieve and hold the correct occlusion for segment reduction and plating. Traditionally, this is achieved using ball hooks and brackets. The problems inherent in this technique include inadequate number and/or position of the ballhooks and perioperative shearing off the brackets. Recently, several authors have advocated the use of transosseous alveolar screw techniques to establish easy, quick and safe maxillomandibular fixation, in facial trauma surgery^1,2 (Arthur and Bernardo, 1989; Jones, 1999). Similar methods are applic-able as an alternative to orthognathic surgery.

The use of wires passed around conventional trans-osseous screws is a good alternative treatment for maxillomandibular fixation, but the wire can slip over the head of the screw and there are problems with mucosal coverage. Specially designed bone ‘capstan’ screws dedicated to temporary IMF are now available (Surgical Technology Ltd, 44-46 Lower Bridgeman Street, Bolton BL2 1DG, U.K.)

Features

Screws are manufactured in titanium with a 2-mm diameter self-tapping thread. They have a capstan style head and are inserted and removed with a centre drive hexagonal screwdriver. They are available in thread lengths 10–16 mm.

Method

Intra-operatively holes are pre-drilled at the junction of the attached and reflected mucosa, avoiding the roots of teeth. Drilling may be performed trans-mucosally—a gingival incision is not required. The appropriate thread length is selected and the screw placed using water as coolant. The best position has been found to be between the canine and first premolar. One screw in each quadrant is usually sufficient. Fixation can be achieved with either stainless steel wire or small elastic bands (Fig. 1).

View larger version (132K): [in this window] [in a new window]   FIG. 1 IMF screws in situ with elastics.

Advantages

1. Decreased operating time.
   
2. Easy painless removal in the outpatient clinic, usually without the need for anaesthesia.
   
3. Ideal for use when teeth have been crowned or bridged.
   

Cost

The price for a pack of 10 is between £139.60 and £149.60, depending on screw length.

References

Arthur, G. and Bernardo, N. (1989)A simplified technique of maxillo-mandibular fixation,Brit. J. Oral Maxillofac. Surg. 47: 1234.

Jones C. (1999)The intermaxillary screw: a dedicated bicortical bone screw for temporary intermaxillary fixation,Brit. J. Oral Maxillofac. Surg. 37: 115–6.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thota, L. G. Articles by Mitchell, D. A. Search for Related Content PubMed PubMed Citation Articles by Thota, L. G. Articles by Mitchell, D. A.