2017-18 HSC Section 3 Green Book

Volume 137, Number 1 • Hybrid Maxillomandibular Fixation System

Limitations include the retrospective nature of the study. A prospective study comparing the SMARTLock system to Erich arch bars would be needed for the most accurate comparison. This study also had a moderate sized sample size, but large sample sizes are needed to increase the power of the study. Although follow-up was over 8 weeks (59 days), this may not be long enough to determine the long-term outcome of root damage, as patients may become symptomatic in the future by develop- ing either endodontic of periodontal lesions. This study supports the use of the Stryker SMARTLock Hybrid system as an alternative to traditional Erich arch bars. Overall, the SMART- Lock system appears to be safe and easy to use, can be applied quickly, and has a cost similar to that of Erich arch bars. It is important that the surgeon use expertise in treatment planning and previous surgical experience to determine appro- priate case selection, as this system is not ideal in all situations. Prospective studies are needed in the future regarding this system to determine long-term outcomes and cost effectiveness. Chan M. Park, M.D., D.D.S. Division of Oral and Maxillofacial Surgery Highland Hospital Alameda County Medical Center references 1. Ayoub AF, Rowson J. Comparative assessment of two meth- ods used for interdental immobilization. J Craniomaxillofac Surg . 2003;31:159–161. 2. Jones DC. The intermaxillary screw: A dedicated bicortical bone screw for temporary intermaxillary fixation. Br J Oral Maxillofac Surg . 1999;37:115–116. 3. Coburn DG, Kennedy DW, Hodder SC. Complications with intermaxillary fixation screws in the management of frac- tured mandibles. Br J Oral Maxillofac Surg . 2002;40:241–243. 4. Colettie DP, Salama A, Caccames FJ Jr. Application of inter- maxillary fixation screws in maxillofacial trauma. J Oral Maxillofac Surg . 2007;65:1746–1750. 5. Hashemi HM, Parhiz A. Complications using intermaxillary fixation screws. J Oral Maxillofac Surg . 2011;69:1411–1414. 6. Rai A, Datarkar A, Borle RM. Are maxillomandibular fixa- tion screws a better option than Erich arch bars in achieving maxillomandibular fixation? A randomized clinical study. J Oral Maxillofac Surg . 2011;69:3015–3018. 7. Stryker Corp. Stryker craniomaxillofacial. Available at: http:// www.accessdata.fda.gov/cdrh_docs/pdf12/K122313.pdf. Accessed February 9, 2015. 8. Stryker Corp. Early product surveillance. Available at: www. hybridmmf.com. Accessed February 10, 2015. 9. Chao A, Hulsen J. Bone-supported arch bars are associated with comparable outcomes to Erich arch bars in the treat- ment of mandibular fractures with maxillomandibular fixa- tion. J Oral Maxillofac Surg . 2015;73:306–313. 1411 East 31st Street Oakland, Calif. 94602 cpark1@pacific.edu

Table 10. Comparison of Intermaxillary Fixation Screw Radiographic Tooth Involvement Study % Kendrick et al. (present study) 7.5 Far and Whear, 2002 14 41.9 Fabbroni et al., 2004 15 27.1 Rai et al., 2011 6 5.81

Cost analysis showed that the use of the SMARTLock system is comparable to that of tra- ditional Erich arch bars. Although the SMART- Lock system is much more expensive, the overall cost is comparable when factoring in the amount of time saved in the operating room. The mean reduction in time spent using the SMARTLock system was 39.9 minutes. This may be important in use of operating room time and decreasing the amount of time patients spend under general anesthesia. The use of the SMARTLock system would be beneficial for patients with significant comorbidities by decreasing the total time under general anesthesia. Fig. 5. ( Above ) Clinical photograph demonstrating sequelae from screw placement into the root of tooth 8 (right maxillary central incisor). Notice the discoloration of the tooth compared with the surrounding teeth. ( Below ) Pantomogram of the same patient. Notice the screw placement into the root of tooth 8.

14