Resident Manual of Trauma to the Face, Head and Neck

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.

y y Start by counting 18 lugs. y y Position the bars so the lugs open away from the crowns to allow MMF wires. y y 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. y y Position the patient into maximum intercuspation, and place MMF wires or elastics.

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Resident Manual of Trauma to the Face, Head, and Neck