Atraumatic placement of circummandibular wires: A technical note

Abstract

Fractures of the mandible are relatively uncommon in children as compared to that of adults. When they occur, the problems associated with their management are complicated due to the presence of the tooth bud and potential growth disturbance. Various management protocols are discussed in the literature. Most authors agree that the ideal method is to use an acrylic splint because it is easy to place and reduces the risk to jaw growth. These splints are secured to the reduced jaw by circummandibular wiring, which is a relatively simple technique. The authors describe their experience with a new atraumatic technique for the placement of circummandibular wires using a 16 gauge intravenous cannula stillete.

Management of mandibular fractures in children differ from that in adults because of anatomical variation, rapidity of healing, degree of the patient co-operation and the potential for changes in mandibular growth . The treatment of fractures in the paediatric mandible depends on the child’s age and the stage of tooth development. In children, the mandibular cortex is thin and less dense than in adults, and the presence of the tooth buds throughout the body of the mandible must be considered when carrying out an open reduction. Trauma to the developing tooth buds and partially erupted teeth may occur when placing intraosseous wires or plates and screws for rigid fixation . Complications such as infection, sensitization and mutagenic effects 5 warrant more surgery for plate removal.

Many paediatric mandible fractures can be treated without surgical exploration of the fracture site . In children, the frequent absence of the teeth due to primary teeth exfoliation and the poor retentive shape of deciduous teeth crowns make the traditional use of arch bars and interdental ligature impossible to apply. Splinting the fractured paediatric mandible with an acrylic splint, retained by circummandibular wires, remains a viable option . The authors describe a new atraumatic technique for placing circummandibular wires using an intravenous cannula stillete (IVCS).

Technique

The treatment plan was to use an acrylic splint, retained by three circummandibular wires, one in the anterior and two in the posterior region. The circummandibular wiring was carried out using a 16 gauge IVCS instead of the conventional awl.

The IVCS was passed percutaneously from the submandibular region and exited in the lingual side close to the alveolus, a 26 gauge wire was passed through the lumen of the IVCS and clamped intraorally ( Fig. 1 ). The tip of the IVCS bevel should always be opposite to that of the winglet.

Fig. 1
IVCS inserted percutaneously, exited on the lingual side intraorally, and wire passed through the lumen.

The needle was railroaded along the wire until the lower border of the mandible was felt ( Fig. 2 ). The IVCS was then passed on the buccal side in proximity to the bone. During buccal insertion, the IVCS was rotated such that the bevel was on the leading side and the wire on the non-leading side ( Fig. 3 ).The needle and the excess wire within were removed after cutting the desired length of wire intraorally at the bevel ( Fig. 4 ).

Feb 8, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Atraumatic placement of circummandibular wires: A technical note
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