exercise modules

EXERCISE MODULES

DR SUDIPTA CHANDRA

MBBS- NRSMCH KOLKATA 1998

MS (ENT)- MLNMCH ALLAHABAD 2005

AMA CERTIFICATION FOR MANUSCRIPT REVIEW 2007

EDITORIAL BOARD MEMBER IJDMR 2014

CONSULTANT ENT, HEAD NECK & MAXILLO-FACIAL SURGEON

BELLE VUE CLINIC & HOSPITAL, KOLKATA

CLOSED REDUCTION

INDICATION

1) NONDISPLACED & FAVOURABLE FRACTURES

2) GROSSLY COMMINUTED FRACTURES

3) EDENTULOUS ATROPHIC MANDIBLE

4) CHILDHOOD FRACTURES

5) CONDYLAR FRACTURES

CONTRA-INDICATION

1) PATIENTS WITH POORLY CONTROLLED

SEIZURES

2) PATIENTS WITH COMPROMISED PULMONARY

FUNCTION

3) PATIENTS WITH PSYCHIATRIC/ NEUROLOGICAL

DISORDERSKumar PD. Wiring techniques in Maxillofacial Surgery

INDIRECT INTERDENTAL- IVY LOOP/ EYELET

INDICATION 1) STABILIZATION OF MULTI-FRAGMENT FRACTURE

2) FIXATION OF IMF

PRE-REQUISITE TWO ADJACENT TEETH HAS TO BE PRESENT IN EACH

QUADRANT BECAUSE 1 OR 2 EYELETS HAS TO BE

PLACED IN EACH QUADRANT

MATERIAL MULTIPLE 20 cm 26 gauze PRE-STRETCHED STAINLESS

STEEL WIRES


METHOD 1) LOOPS ARE FORMED IN THE CENTRE OF WIRE

AROUND THE BEAK OF A TOWEL CLIP/ SHANK OF

DENTAL BURR & TWISTED THRICE WITH 2 TAIL

ENDS. THESE CAN BE PRE-FORMED & STORED IN COLD

STERILIZING SOLUTION FOR EMERGENCY USE. 2 TAIL

ENDS OF EYELET ARE PASSED THROUGH THE SELECTED

INTERDENTAL SPACE FROM BUCCAL TO LINGUAL SIDE.


METHOD 2 & 3) ONE END OF THE WIRE IS PASSED AROUND

THE DISTAL TOOTH LINGUALLY & BROUGHT

THROUGH THE DISTAL INTERDENTAL SPACE TO

THE BUCCAL SIDE & THREADED THROUGH THE

PREVIOUSLY FORMED LOOP. THE OTHER WIRE TAIL IS CARRIED

AROUND THE MESIAL TOOTH LINGUALLY & BROUGHT OUT TO THE

BUCCAL SURFACE THROUGH THE MESIAL

INTERDENTAL SPACE, WHERE IT MEETS THE FIRST TAIL

END WIRE.


METHOD 4) THE 2 WIRES ARE CROSSED & TWISTED

TOGETHER & THE LOOP IS ADJUSTED & BENT TOWARDS

GINGIVA. THE MANDIBULAR WIRE EYELETS CAN BE

SECURED TO MAXILLARY EYELETS BY JOINING WIRES.

ADVANTAGE 1) BRIDGING WIRES CAN BE REMOVED WHENEVER

REQUIRED WITHOUT DISTURBING THE MAIN WIRING.

2) EVEN WHEN THERE IS BREAKAGE OF WIRE DURING

FIXATION, ONLY THAT EYELET CAN BE REMOVED &

REPLACED.

ARCH BAR FIXATION

INDICATION 1) STABILIZATION OF MULTI-FRAGMENT FRACTURE

2) FIXATION OF IMF

PRE-REQUISITE BOTH SIDE 1ST MOLARS MUST BE PRESENT

MATERIALS ARCH BARS (FLAT STURDY STAINLESS STEEL BARS ON

WHICH FLEATS OR HOOKS ARE ATTACHED)

MULTIPLE 15 cm 26 gauze PRE-STRETCHED STAINLESS

STEEL WIRES

PRE-

FABRICATED

CUSTOM

MADEACRYLATED

ARCH BAR FIXATION

METHOD 1) THE ARCH BAR IS MEASURED TO FIT FROM 1ST

MOLAR TO 1ST MOLAR. IT IS PLACED IN SUCH A WAY

THAT THE FLEATS FACE TOWARDS THE GINGIVAL

MARGIN. NOW 15 cm WIRE IS TAKEN STARTING FROM

THE DISTAL TOOTH, THE WIRE IS PASSED FROM BUCCAL

TO LINGUAL SIDE BELOW THE ARCH BAR AND FROM

LINGUAL TO BUCCAL ABOVE THE ARCH BAR & TWISTED

TOGETHER.

ARCH BAR FIXATION

METHOD 2) NOW 15 cm WIRE IS TAKEN STARTING FROM THE

DISTAL TOOTH, THE WIRE IS PASSED FROM BUCCAL TO LINGUAL

SIDE BELOW THE ARCH BAR AND FROM LINGUAL TO BUCCAL

ABOVE THE ARCH BAR & TWISTED TOGETHER. THIS IS

CONTINUED FOR ALL THE TEETH & THE ARCH BAR IS SECURED.

ADVANTAGE WHILE PLACING AN ARCH BAR ACROSS A DEPRESSED

FRACTURE SEGMENT, IT IS CUT AT THE FRACTURE

SITE & PLACED SEPARATELY.

CLOSED REDUCTION

ADVANTAGES

1) MORE CONSERVATIVE PROCEDURE

2) NO MAJOR SURGICAL COMPLICATIONS

3) CAN BE DONE IN MEDICALLY COMPROMISED

PATIENTS

DISADVANTAGES

1) AIRWAY COMPROMISE DUE TO IMF

2) LOSS OF FUNCTION OF TISSUES

3) DECREASED NUTRITIONAL STATUS OF

PATIENTS

4) ONLY OCCLUSION IS TAKEN AS A GUIDE

5) DIFFICULTY IN SPEECH

6) SOCIAL INCONVENIENCE

EFFECTS OF PROLONGED IMF

1) FORMATION OF ADHESIONS IN THE

JOINTS

2) THINNING & NECROSIS OF

ARTICULAR CARTILAGE

3) DISUSE ATROPHY/ OSTEOPOROSIS

OF BONE

4) DISUSE ATROPHY/ WEAKENING OF

MUSCLES

MAXILLO-MANDIBULAR FIXATION SCREWS

INDICATIONS 1) LONG-TERM FIXATION OF MAXILLO-MANDIBULAR

FRACTURES

2) SIMPLE ALVEOLAR FRACTURE

3) TRANSVERSE PALATAL FRACTURES

4) ALVEOLAR FRACTURE IN EDENTULOUS PERSON

5) OPEN FRACTURES

PRE-REQUISITE INTACT ANTERIOR VESTIBULAR, CANINE & PREMOLAR

REGIONS

MATERIALS TITANIUM/ SS SCREWS WITH OR WITHOUT HANGER

PLATES, 26 GAUZE WIRE FOR TEMPORARY/ 22

GAUZE FOR LONG-TERM, DRILL


METHOD MMF SCREWS ARE INSERTED EITHER THROUGH

PERFORATION OF THE CLOSED MUCOSA OR AFTER AN

OPEN APPROACH AFTER EXPOSING THE BONY

SURFACE. THE SCREW TIP SHOULD NOT FULLY

PENETRATE THE INNER CORTICAL LAYER. SIMILAR LEVEL

SCREWS ARE ALSO INSERTED IN THE OTHER ALVEOLUS TOO. A

WIRE IS BENT AROUND BOTH THE SCREW HEADS AND

THE ENDS HELD TOGETHER, TWISTED & BURIED

INWARDS. THINNER WIRES WITH HANGER PLATES

MAY BE USED FOR LONG-TERM FIXATION. WIRES &

SCREWS ARE REMOVED WHEN THE NECESSAITY IS OVER.


CONTRA-INDICATIONS 1) ALVEOLAR FRACTURES NEEDING DENTAL

SPLINTING

2) SAGITTAL PALATAL FRACTURE (NEEDS

PLATING)

3) MULTIPLE MAXILLO-MANDIBULAR FRACTURES

4) SEVERE BONY ATROPHY

5) PATHOLOGICAL BONE

6) UNERUPTED TEETH/ DENTAL FOLLICULE

7) CONGENITAL/ ACQUIRED BLEEDING

DISORDERS

ERNST LIGATURES

INDICATION 1) TEMPORARY FIXATION PRIOR TO DEFINITIVE SURGERY

2) INTRA-OP MMF DURING SURGERY FOR SIMPLE

FRACTURE

PRE-REQUISITE 2 INTACT NEIGHBOURING TEETH PREFERABLY

PREMOLARS IN THE SAME SEGMENT OF ONE DENTAL ARCH,

NO JAW MALFORMATION

MATERIAL 15 cm 26 GAUZE STAINLESS STEEL WIRE

METHYL METHACRYLATE APPLICATOR

CONTRA-INDICATION 1) COMMINUTED & DISPLACED FRACTURE

2) UNSTABLE SEGMENTED FRACTURE

3) COMPLEX FRACTURES

ERNST LIGATURES

METHOD 1) 1 END OF THE WIRE IS PASSED THROUGH THE

INTERDENTAL SPACE BETWEEN 2ND PREMOLAR & 1ST

MOLAR. THEN IT IS THREADED BACK FROM LINGUAL

TO BUCCAL SURFACE THROUGH THE

INTERDENTAL SPACE BETWEEN 1ST & 2ND PREMOLAR. OTHER

END OF THE WIRE IS PASSED THROUGH THE INTERDENTAL

SPACE BETWEEN CANINE & 1ST PREMOLAR & THEN IT IS

THREADED BACK FROM LINGUAL TO BUCCAL SURFACE

THROUGH THE INTERDENTAL SPACE BETWEEN 1ST & 2ND

PREMOLAR. 1 END SHOULD BE ABOVE & THE OTHER END

SHOULD BE BELOW THE HORIZONTAL SEGMENT OF

WIRE.

C

M1

ERNST LIGATURES

METHOD 2) THE WIRE ENDS ARE TWISTED TOGETHER &

TIGHTENED. LIGATURES ARE ADDED IN THE SAME

WAY IN THE OTHER 3 SEGMENTS OF THE DENTAL

ARCHES TO FORM 2 SYMMETRICAL PAIRS. ALL THE

WIRE ENDS SHOULD BE AT LEAST 4-5 cm IN LENGTH.

THEN THE CORRECT OCCLUSION IS ASSURED & THE WIRE

ENDS OF EACH PAIR OF LIGATURES ARE TWISTED TOGETHER.

CARE SHOULD BE TAKEN NOT BREAK ANY WIRE AT THIS POINT.

THEN THE WIRE ENDS ARE CUT & BENT TOWARDS

THE TEETH TO PROTECT THE ORAL MUCOSA.

ADDITIONAL STABILIZATION CAN BE OBTAINED USING

METHYL METHCRYLATE TO REINFORCE THE

LIGATURE.

EDENTULOUS MANDIBULAR FRACTURE

OBSERVATION & SOFT DIET- NONUNION

CLOSED REDUCTION BY WIRING IN

PATIENT’S DENTURES OR FABRICATING

GUNNING STYLE SPLINTS WITH POST-

OP MMF- MALUNION/ NONUNION

OPEN REDUCTION INTERNAL FIXATION-

BEST BUT DIFFICULT

EXTERNAL FIXATOR- MALUNION/

NONUNION

EDENTULOUS MANDIBULAR FRACTURE

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