I read the paper of K harkar et al. with great interest. I think this novel technique is a good alternative for other ligature techniques (Ernst, Ivy loop, etc.) used for intermaxillary fixation (IMF). However I have some concerns regarding the safety of this procedure.

For patients that are placed in IMF, nasal bleeding and postoperative vomiting can cause airway obstruction and aspiration pneumonia. Therefore, they may benefit from the releasing fixation in the initial care of obstruction or vomiting . It is a traditional practice to keep wire cutters available by the patient at all times to enable quick release of the jaws in emergency following IMF.

The technique proposed by K harkar et al. seems not so easy to release the fixation for the patient due to the palatal wirings. Therefore, to my opinion, the surgeons’ awareness plays an important role in safety of this procedure. The individuals carrying this kind of intermaxillary fixation should be strictly warned against the possibility of aspiration. Furthermore, in unconscious patients, a suction catheter is essential to overcome life threatening complications.