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General considerations
Mandibulomaxillary fixation (MMF) can be used
either intraoperatively to establish the correct
occlusion or as part of postoperative management
of the patient’s injury. MMF may be
accomplished with wires or training elastics
depending on the overall treatment plan for the
patient.
With wires
The wire loop is placed over the maxillary and
mandibular lugs of the arch bar and the wire loop
is tightened.
MMF completed with wire fixation. At least three
wires, a posterior wire loop in each side, and an
anterior wire loop will provide stable fixation.
Elastics
Some surgeons prefer MMF with elastics for
intraoperative management of the occlusion.
Additionally, postoperative training elastics can
be used to manage condylar fractures in a closed
manner.
TYPES OF WIRING TECHNIQUES
1. ESSIG’S WIRING
2. GILMER’S WIRING
3. RISDON’S WIRING
4. IVY EYELET WIRING
5. COL. STOUT’S MULTILOOP WIRING
ARMAMENTARIUM
Presterilized 26 gauge stainless steel wire sloop
or wires cut into of 20cm each.
Two needle holders or wire holders.
Wire cutters.
IVY EYELET LOOP WIRING
Simple and effective method for the reduction
and immobilization of jaw fractures.
Use in combination with gunning type of splint in
an opposing edentulous arch
ADVANTAGE:
Fixation may be released by removal of
intermaxillary ligatures.
Even when there is breakage of a wire during
fixation only that eyelet can be removed and
replaced.
Eyelets are constructed by holding a 6inch (15cm)
length of wire by a pair of artery forceps at either
end and giving the middle of the wire two turns
around a piece of round bur 3mm in diameter
which is fixed in an upright position.
After selecting the teeth to be wired both ends of
the eyelet wire are inserted through the
interdental space from the outer surfaces of the
teeth. As the wires emerge on the lingual or
palatal side they are gripped by a second pair of
forceps that is manipulated by an assistant who,
passes the wires back through the adjacent
mesial and distal interdental space
The operator grips each wire as it emerges from the
space and pulls it through. The distal wire is
pulled through the loop of the eyelet and both
ends are pulled tight and twisted together with
the wire holder. Push the wires down on the
lingual and palatal aspects below the maximum
diameter of the teeth with an instrument
otherwise eyelet will tend to be displaced up the
tooth and become loose.
The ends of the wires are cut and bent into the
interdental spaces towards the gingiva to prevent
irritation of the lips and cheek.
The wires should be tightened in the molar area
first on one side and then on the other, so
working round to the incisor area. If the wires
are tightened on one side first a cross over bite is
produced and if the anterior wires are tightened
before the wires in the molar area a posterior
open bite results. the wires may be twisted very
tight on the multirooted teeth, but some caution
should be exercised with single rooted teeth for
they may be extracted as a result of force from
twisting the tie wire over-tight.
About five eyelets are applied in upper and five in
the lower jaw and then the eyelets are connected
with the wires passing through the eyelets from
the upper to the lower jaw.