Intermaxillary screw fixation in mandibular fracture repair.

PURPOSE: To be successful, mandibular fracture reduction requires restoring premorbid occlusion. Intermaxillary fixation (IMF) is a founding principle of accurate mandibular fracture repair. Although arch bars are currently the standard in securing IMF, IMF screws have many potential benefits and should therefore not be overlooked. The goals of this study were to evaluate the effectiveness of IMF screws in the management of mandibular fractures, describe the technique, and identify those who will benefit from it without compromising the end results. MATERIALS AND METHODS: Thirty-six consecutive patients with single or multiple displaced fractures of the mandible were treated using screw IMF. Open reduction internal fixation was then accomplished in the usual fashion. Postoperative plain films were used to evaluate fracture reduction and screw placement. Data were collected prospectively from clinical and radiologic evaluations at regular follow-up appointments. RESULTS: Thirty-five (97.2%) of 36 patients demonstrated normal occlusion at the follow-up examination 6 weeks postoperatively. One case of root fracture and four cases of root impingement by screws were observed at the follow-up examinations. CONCLUSIONS: Cortical bone screws offer a reliable alternative to more traditional methods of obtaining IMF in the treatment of mandibular fractures and present many advantages to the surgeon and the patient. Their use may be limited to specific clinical situations and potential consequences, of which the surgeon must be aware. Adequate preoperative planning is therefore essential to maximize successful results.