J Oral Maxillofac
Surg
49210-211.1991
A Simplified Method for Identification of Maxillomandibular Fixation Wires STEVEN J. TRAUB, DDS,* AND DANIEL J. TRAUB, DDS*
The use of maxillomandibular fixation (MMF) is an important means of reduction and fixation of maxillofacial fractures as well as fixation after orthognathic surgical procedures. When MMF is used, there commonly arises in the postoperative period the question of what indications might exist that would necessitate early and/or immediate release of the patient from such fixation. In addition, the oral and maxillofacial surgeon is commonly asked by nursing personnel about the location of fixation wires that would need to be cut if an emergent or early release of MMF would be indicated. It is the intent of this report to describe a simplified method of identification of wires used for MMF so that quick and efficient release can be obtained if the need arises.
FIGURE 1. Cut section of PVC suture boot on proximal portion of 24-g stainless steel wire loop.
a rosette (Fig. 3). Adequate visualization marked wire loops is thus obtained.
of all
Discussion Postoperatively, airway problems can occur either on an immediate or a delayed basis. In the immediate postoperative period, airway problems can occur rapidly, especially if general anesthesia has been used. In spite of the use of nasopharyngeal airways, buccal airways, and the availability of suction apparatus, quick release devices, elastic bands,
Technique Following proper application of Erich arch bars to the maxillary and mandibular dentition, and on verification of the proper occlusal relationship, 24gauge, stainless steel wire loops that will be used for MMF are prepared. Three-millimeter sections of commercially available polyvinyl chloride Suture Aid Booties (Oxboro-Medical, Minneapolis, MN) are placed on the stainless steel wire loop opposite the twisted end (Fig. 1). Following placement of the wire loop on the arch bars, and properly securing it to the lugs, the plastic suture boot is then clearly visible posteriorly. The anterior portion of the wire loop is tightened and the twist is cut with the wire cutters in the usual fashion (Fig. 2). At this time, a second 3-mm section is placed over the twisted anterior portion of the wire, which is then formed into * In private practice of Oral and Maxillofacial Surgery, Albuquerque, NM. Address correspondence and reprint requests to Dr Steven J. Traub: Albuquerque Oral and Maxillofacial Surgery Group, 8400 Osuna Rd NE, Suite 6-B. Albuquerque, NM 871 Il. 0 1991 American geons
Association
of Oral and Maxillofacial
Sur-
FIGURE 2. boot visible.
0278-2391/91/4902-0021$3.00/0
210
Wire loop attached to arch bars with PVC suture
TRAUB AND TRAUB
FIGURE 3. Wire loops attached to arch bars with suture boots located proximally and distally.
211
and the ubiquitous use of wire cutters at the bedside, danger still exists. It has long been accepted that there should be wire cutters available at bedside for rapid release of MMF if necessary; however, uncontrolled or misguided attempts at release of MMF can be time-consuming and potentially harmful. Moreover, in the subsequent period of maxillomandibular fixation, which usually involves up to 6 weeks, situations in which release of fixation may be indicated would require it to be done either by a family member, the patient, or by an uninitiated bystander. It is with this in mind that a simplified method of identification of the stainless steel wire loops that will permit efficient and controlled release of fixation has been developed. However, this does not supplant the need for proper education of health care personnel involved in immediate postoperative care of the patient, as well as family members who may be called on to perform this service.
Surg
49210-211.1991
A Simplified Method for Identification of Maxillomandibular Fixation Wires STEVEN J. TRAUB, DDS,* AND DANIEL J. TRAUB, DDS*
The use of maxillomandibular fixation (MMF) is an important means of reduction and fixation of maxillofacial fractures as well as fixation after orthognathic surgical procedures. When MMF is used, there commonly arises in the postoperative period the question of what indications might exist that would necessitate early and/or immediate release of the patient from such fixation. In addition, the oral and maxillofacial surgeon is commonly asked by nursing personnel about the location of fixation wires that would need to be cut if an emergent or early release of MMF would be indicated. It is the intent of this report to describe a simplified method of identification of wires used for MMF so that quick and efficient release can be obtained if the need arises.
FIGURE 1. Cut section of PVC suture boot on proximal portion of 24-g stainless steel wire loop.
a rosette (Fig. 3). Adequate visualization marked wire loops is thus obtained.
of all
Discussion Postoperatively, airway problems can occur either on an immediate or a delayed basis. In the immediate postoperative period, airway problems can occur rapidly, especially if general anesthesia has been used. In spite of the use of nasopharyngeal airways, buccal airways, and the availability of suction apparatus, quick release devices, elastic bands,
Technique Following proper application of Erich arch bars to the maxillary and mandibular dentition, and on verification of the proper occlusal relationship, 24gauge, stainless steel wire loops that will be used for MMF are prepared. Three-millimeter sections of commercially available polyvinyl chloride Suture Aid Booties (Oxboro-Medical, Minneapolis, MN) are placed on the stainless steel wire loop opposite the twisted end (Fig. 1). Following placement of the wire loop on the arch bars, and properly securing it to the lugs, the plastic suture boot is then clearly visible posteriorly. The anterior portion of the wire loop is tightened and the twist is cut with the wire cutters in the usual fashion (Fig. 2). At this time, a second 3-mm section is placed over the twisted anterior portion of the wire, which is then formed into * In private practice of Oral and Maxillofacial Surgery, Albuquerque, NM. Address correspondence and reprint requests to Dr Steven J. Traub: Albuquerque Oral and Maxillofacial Surgery Group, 8400 Osuna Rd NE, Suite 6-B. Albuquerque, NM 871 Il. 0 1991 American geons
Association
of Oral and Maxillofacial
Sur-
FIGURE 2. boot visible.
0278-2391/91/4902-0021$3.00/0
210
Wire loop attached to arch bars with PVC suture
TRAUB AND TRAUB
FIGURE 3. Wire loops attached to arch bars with suture boots located proximally and distally.
211
and the ubiquitous use of wire cutters at the bedside, danger still exists. It has long been accepted that there should be wire cutters available at bedside for rapid release of MMF if necessary; however, uncontrolled or misguided attempts at release of MMF can be time-consuming and potentially harmful. Moreover, in the subsequent period of maxillomandibular fixation, which usually involves up to 6 weeks, situations in which release of fixation may be indicated would require it to be done either by a family member, the patient, or by an uninitiated bystander. It is with this in mind that a simplified method of identification of the stainless steel wire loops that will permit efficient and controlled release of fixation has been developed. However, this does not supplant the need for proper education of health care personnel involved in immediate postoperative care of the patient, as well as family members who may be called on to perform this service.
