Use of Arch Bars versus IMF-Screws in Maxillomandibular Fixation of Mandibular Fractures: A Randomised Prospective Study.

Abstract

Background: Traditionally, arch bars are used for mandibulomaxillary fixation (MMF) following mandibular fractures. Intermaxillary fixation screws (IMFS) are a suitable alternative to mitigate the drawbacks of arch bar fixation.

Aims and objectives: We compared the use of arch bars versus IMFS for treatment of mandibular fractures including evaluation of sonographic findings and the patients' quality of Life (QoL).

Study design: This is a randomised prospective study.

Setting: The study was conducted at the Department of Oral and Maxillofacial Surgery, University of Maiduguri Teaching Hospital.

Materials and methods: Fifty patients with mandibular fractures were recruited and randomly divided into two groups, 25 each in the arch bars and IMFS treatment groups. The parameters evaluated were as follows: mouth opening, malocclusion, pain, fracture healing using an ultrasound scanner, operating time, wire-prick injuries, oral hygiene, and QoL.

Results: There was a significantly higher pain score by the 3^rd and 6^th postoperative weeks (P = 0.015 and P = 0.003, respectively) and shorter operating time (P < 0.001) in the IMFS group, while a notable higher wire-prick injury (P < 0.001) and poor oral hygiene (P = 0.25) were observed in the arch bar group. An ultrasound scan at 6 postoperative weeks showed complete hyperechoic bridging callus in (61.5%) the arch bar group and (50%) in the IMF screw group, with no statistically significant difference. Regarding the QoL, patients treated with arch bars had more difficulty in continuing with their normal diet and indicated "they will not undergo the same treatment again." On the other hand, IMFS patients had significantly isolated themselves because of feelings of bad mood, and their sleep and speech patterns were significantly affected.

Conclusions: Although some similarities were observed in both groups, this study observed that IMFS addressed some of the limitations associated with arch bars such as prolonged operative time, wire-prick injury, and poor oral hygiene. Therefore IMFS is relatively safer and can be used for long-time MMF.

Trial registration number: PACTR202408851121914.

Date of registration: 04 July 2024, "retrospectively registered."

Clinical trial registry: Pan African clinical trials registry.