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Resident Manual of Trauma to the Face, Head, and Neck
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Chapter 5: Mandibular Trauma
1. Closed Reduction
Closed reduction can be accomplished with a variety of techniques with
and without the dentition. When teeth are present, circumdental wire,
arch bars, IMF screws, acid etch brackets are used.
a. Erich Arch Bars
Arch bars are considered the standard in MMF. These are cut and fitted
on both dentitions. If intended for long term use, patients must be
aware of the risks to teeth and periodontum and have adequate
follow-up care (Figure 5.11).
Figure 5.11
Photo of arch bars retained in a patient for 4 years who had forgotten to make a follow-up
appointment.
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Start by counting 18 lugs.
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Position the bars so the lugs open away from the crowns to allow
MMF wires.
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Use 24-gauge stainless steel circumdental wires twisted closed in a
clockwise rotation. Wires may be prestretched to lessen wire stretch-
ing and loosening after surgery. Factory-cut wires may be less sharp
and may lessen the risk of puncture injury.
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Position the patient into maximum intercuspation, and place MMF
wires or elastics.