2017-18 HSC Section 3 Green Book

Stryker SMARTLock Hybrid Maxillomandibular Fixation System: Clinical Application, Complications, and Radiographic Findings PEDIATRIC/CRANIOFACIAL Reprinted by permission of Plast Reconstr Surg. 2016; 137(1):142e-150e.

Douglas E. Kendrick, D.D.S. Chan M. Park, M.D., D.D.S. Jesse M. Fa, D.D.S.

Background: The SMARTLock Hybrid MMF System from Stryker is a newer approach for maxillomandibular fixation. This study was performed to deter- mine the clinical application, complications, radiographic findings, and cost effectiveness of the SMARTLock system. Methods: A retrospective cohort study was performed with the SMARTLock system over 6 months. Demographics, history, fracture location, placement/ removal time, and complications were obtained, along with cost analysis. Results: The authors identified 35 patients with the SMARTLock system. Twen- ty-four patients remained after exclusion criteria. There were 19 male patients (79 percent) and five female patients (21 percent), with a mean age of 30.7 years. The mean application time of the SMARTLock system was 14.4 minutes, and the mean removal time was 10.5 minutes. Three hundred nineteen total screws were placed. The number and percentage of patients with complications associated with the SMARTLock system were as follows: mucosal overgrowth [ n  = 9 (38 percent)], screw loosening [ n = 4 (17 percent)], lip irritation [ n  = 4 (17 percent)], malocclusion [ n = 3 (13 percent)], nonunion [ n = 1 (4 per- cent)], wound dehiscence [ n = 1 (4 percent)], screw loss [ n  = 1 (4 percent)], tooth devitalization [ n = 1 (4 percent)], loose plate [ n = 1 (4 percent)], and plate fracture [ n = 1 (4 percent)]. There were no instances of sharps exposure, tooth loss, or infection. One tooth required endodontic therapy. The number of screws that damaged teeth on cone-beam computed tomographic imaging was 24 (7.5 percent). The cost analysis showed similar cost between Erich arch bars and the SMARTLock system. Conclusions: This study suggests that the SMARTLock Hybrid MMF System is safe and easy to use, and with a cost similar to that of Erich arch bars. Appropriate treatment planning and previous surgical experience should be used to determine appropriate case selection, as this system is not ideal in all situations. ( Plast. Reconstr. Surg. 137: 142e, 2016.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Jacob S. Barber, D.D.S. A. Thomas Indresano, D.M.D. Oakland, Calif.

M axillomandibular fixation, previously known as intermaxillary fixation, is any method used to secure the maxilla and mandible to each other into the appropriate dental occlusion. The use of maxillomandibular fixation is a cornerstone for treating patients with facial trauma and those requiring reconstruc- tive and orthognathic surgery. The three main principles of maxillomandibular fixation are to Copyright © 2015 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000001920 From the University of the Pacific School of Dentistry, High- land Hospital Division of Oral and Maxillofacial Surgery. Received for publication April 30, 2015; accepted August 27, 2015.

establish occlusion, provide stability, and immobi- lize the jaws. There are also additional characteris- tics of an ideal maxillomandibular fixation system (Table 1). A myriad of studies have been per- formed to evaluate application time, advantages, disadvantages, complications, and patient out- comes for different methods of maxillomandibu- lar fixation. 1–6 The purpose of this study was to determine the clinical application, success, com- plications, and radiographic findings when using the SMARTLock Hybrid MMF System (Stryker

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

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