Types of Mandibular Fixation

Mandibular fixation commonly known as jaw fractures are one of the most frequently encountered facial injuries, especially in trauma and accident cases. Fixation of the mandible is a critical step in the management of such fractures to ensure proper alignment, stability, and healing. With advancements in maxillofacial surgery, different types of mandibular fixation techniques have evolved over time. These techniques vary based on the type and location of the fracture, patient condition, and surgical preferences.

One of the key aspects of treating such fractures involves mandibular fixation, a medical procedure aimed at stabilizing the broken segments of the jawbone to promote proper healing. Mandibular fixation not only helps in realigning the bone but also ensures that patients regain normal bite function (occlusion) and facial aesthetics over time. Thanks to advancements in oral and maxillofacial surgery, there are now multiple fixation techniques available each tailored to the severity, location, and complexity of the fracture.

What is Mandibular Fixation?

Mandibular fixation refers to the methods used to stabilize and immobilize a fractured jawbone (mandible) to facilitate proper healing. The process aims to bring fractured segments into alignment and hold them firmly in place until the bone regenerates. Fixation may be either closed or open, depending on the severity and location of the fracture.

In general, mandibular fixation serves three primary purposes

1. Restore dental occlusion (the way teeth fit together)

2. Ensure bone healing by maintaining alignment

3. Preserve facial aesthetics and functionality

Let’s dive into the different fixation methods used by oral and maxillofacial surgeons.

Types of Mandibular Fixation

1. Closed Reduction with Intermaxillary Fixation (IMF) :- Intermaxillary fixation (IMF) is one of the oldest and most conservative methods used for mandibular fracture treatment. It involves wiring the upper and lower teeth together to keep the jaw closed, allowing the bones to heal naturally over time. Arch bars, eyelet wires, or orthodontic brackets are commonly used in this technique.

   While IMF avoids surgical exposure of the fracture site, it can be uncomfortable for patients, limiting oral intake and speech. Patients typically need to remain in fixation for four to six weeks.

   Key Applications :-

   • Simple, non displaced mandibular fractures

   • Medically compromised patients not fit for general anesthesia

   • As a temporary stabilization method before open surgery

   However, with modern advancements, IMF is increasingly being replaced by more rigid and functional fixation methods.

2. Open Reduction and Internal Fixation (ORIF) :- Open Reduction and Internal Fixation, or ORIF, is now considered the gold standard for treating moderate to severe mandibular fractures. This surgical approach involves exposing the fracture site through an incision, realigning the bones, and securing them using plates and screws.

   Titanium miniplates and screws are most commonly used for ORIF. These materials are biocompatible, corrosion resistant, and allow early mobilization of the jaw, thereby minimizing complications.

   Advantages :-

   • Better anatomical alignment and healing

   • Faster recovery time compared to IMF

   • Improved oral function and hygiene post-surgery

   Depending on the location of the fracture, ORIF can be performed through intraoral (inside the mouth) or extraoral (external skin) approaches.

3. Rigid Fixation :- Rigid fixation is a form of ORIF that uses larger plates or reconstruction plates to provide maximum stability, especially in comminuted or atrophic fractures. This method is especially useful in complex fractures, cases with bone loss, or elderly patients with poor bone quality.

   With rigid fixation, early jaw mobility is encouraged, which helps in preserving muscle tone and function. The downside is that it typically requires a more extensive surgical approach and may leave external scars, depending on the incision site.

   Best Suited For :-

   • Comminuted fractures (multiple bone fragments)

   • Mandibular angle and body fractures

   • Pathologic or previously irradiated bone

4. Semi Rigid Fixation :- Semi rigid fixation is a variation of ORIF where smaller, more flexible plates often called miniplates are used. These plates are typically placed in a tension band principle (upper border of the mandible) and are sufficient for many simple to moderately displaced fractures.

   This technique offers a balance between stability and minimal invasiveness. Patients can often resume a normal diet and jaw function sooner than with IMF.

   Advantages :-

   • Less surgical exposure required

   • Minimal interference with surrounding tissues

   • Fewer complications related to plate removal

5. External Fixation :- Though rarely used today, external fixation may still be necessary in certain complex cases, especially when there is extensive infection, bone loss, or poor soft tissue coverage. In this method, pins are inserted into the bone and connected to an external frame outside the skin, which holds the fractured segments in place.

   This technique avoids internal implants, making it a temporary but effective choice when internal fixation is contraindicated.

   Ideal For :-

   • Open fractures with significant soft tissue injury

   • Severely comminuted or infected fractures

   • Pediatric cases with growing bones (in select scenarios)

6. Resorbable Fixation Systems :- A newer innovation in mandibular fixation includes the use of resorbable plates and screws, often made of polymers like polylactic acid (PLA). These systems provide enough strength during the healing phase and then degrade naturally in the body over time, eliminating the need for a second surgery for plate removal.

   Though more expensive, resorbable systems are beneficial in pediatric patients or cases where permanent hardware is undesirable.

   Key Benefits :-

   • No need for second surgery

   • Biocompatible and safe for long term use

   • Reduced long-term foreign body presence

Choosing the Right Fixation Technique

The selection of a mandibular fixation method depends on multiple factors, including

1. Type and location of fracture (e.g., symphysis, angle, condyle)

2. Patient age and general health

3. Presence of missing teeth or bone loss

4. Surgeon’s expertise and available technology

In many cases, a combination of methods may be used to achieve the best outcomes. For example, IMF may be applied temporarily before ORIF, or resorbable plates may be combined with conventional miniplates depending on the patient profile.

Recovery and Aftercare

Regardless of the fixation method, postoperative care is crucial for successful healing. Patients are typically advised to

1. Maintain oral hygiene with mouth rinses

2. Follow a soft or liquid diet initially

3. Avoid trauma or excessive jaw movement

4. Take prescribed antibiotics and painkillers

Follow up appointments are essential to monitor healing progress, and in some cases, hardware may be removed if complications arise.

Conclusion

Understanding the types of mandibular fixation is essential not only for healthcare professionals but also for patients undergoing treatment for jaw fractures. From traditional intermaxillary fixation to advanced resorbable plates, each method has its unique advantages and considerations.