Correction of Traumatic Transverse Mandibular Widening With Interdental Wiring

Abstract

Mandibular symphysis fractures pose several technical challenges for the craniomaxillofacial surgeon. One classic challenge is restoration of the transverse dimension when the mandible is widened secondary to splaying of the lingual cortex. Failure to diagnose or correct this problem can result in widening of the lower facial third, inadequate fracture reduction, and/or a malocclusion. Surgeons have traditionally utilized techniques such as manual pressure to the rami or lingual splint application to address transverse defects intraoperatively. However, these methods may be inadequate in situations with significant widening, such as in the case of concomitant subcondylar fractures. More recently, virtual surgical planning and custom hardware have been utilized to address mandibular widening, though this method also has various shortcomings. In this technical note, the authors present a simple technique using interdental wiring to precisely control mandibular width intraoperatively. The technique is cost effective, does not require an assistant, and can be used in conjunction with any of the above methods. The authors also present a case of secondary reconstruction in which use of this technique was necessary given a large degree of mandibular widening not amenable to reduction and fixation with manual pressure alone.

Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures

“…When the mandibular teeth tilt to the lingual side, it will cause the mandibular angle to turn out, thus widening the lower one-third of the face 18 . The transverse mandibular widening can be well corrected with interdental wiring around the bilateral first and second premolars or overbending of miniplates in adults 9,19 . However, caution is required in children with primary dentition using an absorbable plate.…”

“…However, the fracture of the mandibular symphysis often leads to changes in the width of the mandible, which significantly widens the face of the child 9–11 . The abduction of the lateral condylar crest is likely to lead to Temporomandibular Joint ankylosis if there is no coverage of the articular disk 12–14 .…”

To investigate the clinical application of three-dimensional rigid internal fixation in the treatment of anterior mandibular fractures

“…Due to the weakening of masticatory function and the destruction of the condyle of the growth center, the patient's lower face deformity can be caused, which is common in children. In addition, due to the disorder of mandibular development, the lower face deformity can be caused, and there is no development space for the dental arch, which makes the dental arch narrow and causes the disorder of the occlusal relationship [12].…”