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UW-Madison BME 200 - Maxillomandibular Fixation

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1 Maxillomandibular Fixation Nina Lewis - Team Leader Ashley Phillips- Team Leader Joe Ferris- Communications Sara Karle - BWIG Emily Maslonkowski - BSAC Client: Jeremy Warner, MD Plastic Surgery, UW Medical School Advisor: William Murphy Assistant Professor, Department of Biomedical Engineering October 19, 2005 Abstract: The goal of this project is to create a new technique for fixating a fractured mandible that will be easier and faster to apply than the current method of ‘maxillomandibular fixation’ (MMF). The decision was made to use a design that incorporated aspects of orthodontic braces designed specifically to hold the lower jaw tight against the upper jaw. The device will accomplish this by the use brackets and a power chain attached to a total of 16 molars, and rubber bands strung from the upper jaw to the lower jaw. The patient will wear the device for 4 to 6 weeks or until completion of the healing process.2Problem Definition: Currently, the most common technique of fixating the jaw after a facial fracture is called maxillomandibular fixation (MMF), which requires wiring the mouth shut with the use of arch bars and wires. It has been proposed to us to design a device which will mimic the function of maxillomandibular fixation, but be easier and faster to apply while maintaining an adequate cost of application. Our design needs to securely hold the lower jaw tight to the upper jaw, but also needs to have an emergency quick release system. The device should also be safe for the patient during application and for the 4-6 weeks of healing. Motivation: The first writings about mandible fractures were recorded in the Edwin Smith Papyrus which dates back to 1650 B.C. However, at that time there was no technique available for the treatment of mandible fractures. Individuals with such injuries thus went untreated and commonly faced subsequent complications, often leading to death. Hippocrates was the first to attempt treatment of mandible fractures by using bandages to immobilize the fractured jaw. Occasionally he used gold circumdental wires in the stabilization process as well. A textbook written in Salerno, Italy was the first to mention the importance of correct occlusion when treating mandible fractures. The first person to come up with the theory of maxillomandibular fixation was Guglielmo Salicetti, in 1492, introducing the method in which one would “tie the teeth of the uninjured jaw to the teeth of the injured jaw.” Since this time, many other people have slightly altered Salicetti’s technique, though the original principle remains.3The current technique of MMF is not only outdated, but also tedious and time consuming. The application of the fixation device takes an average of 40 minutes, though the exact time varies depending on the difficulty the surgeon experiences in threading the circumdental wires about the teeth. A picture of this procedure can be seen in Figure 1. The small wires are often hard to manipulate when inserted in the correct position above or below the arch bar. Thus, our client is interested in developing a new device for the treatment of mandible fractures which will use the same principle of fixation, but be quicker and simpler to apply. Client Requirements: While the client has provided our group with the freedom to be creative in designing a new MMF technique, he has also provided multiple design constraints in order to ensure safety to the patient. Our device must be of an appropriate size and weight as to provide minimal discomfort to the patient. Forces must not be exerted on front teeth as they are easily moved out of alignment. The device must also be cost and time effective when compared to the current technique that costs $175 and takes an Figure 1. Picture of the current MMF technique4average of forty minutes to complete the procedure. Due to the nature of jaw fixation, the patient must be able to obtain nutrients from liquid foods with the help of a syringe. Most importantly, the mechanism must incorporate a way to quickly release the lower jaw from the upper jaw in case of an emergency. Background: Facial Fractures: A Brief Overview The mandible is the second most commonly fractured bone of the face, after the nasal bones. In a paper by Ellis, a study of 4711 patients with facial fractures found that 45 percent were mandible fractures. The most common cause of mandible fractures was assault, followed by motor vehicle accidents, falls, and sporting accidents. The exact fracture sites were influenced by the cause of injury, the prominence of the mandible, and the individual’s areas of weakness. The most commonly fractured sites were the angle, the body, and the condyle which are shown in Figure 2. There are three steps in the healing of most mandible fractures. First, reduction of the fracture must be accomplished by realigning the bones into their original positions. Second, the fracture must be fixed into place by means of MMF, internal fixation, or external fixation. Lastly, sufficient time is needed for the important healing and rehabilitation process.5 Methods of Fixation: While MMF is the most commonly used treatment for mandible fractures, internal and external fixation are occasionally used as well. Internal fixation involves the use of plates and wires or screws attached directly to the bones to hold them securely in their correct positions. This procedure involves the use of anesthesia. Internal fixation is shown in Figure 3. External fixation, though less commonly used, involves the use of surgical pins to attach a rigid external fixation device which holds the jaw in place. This type of fixation is shown in Figure 4. Depending on the severity of the case, a combination of the treatment methods may be used. Figure 3. Internal fixation Figure 4. External fixation Maxillomandibular Fixation: A Brief Overview MMF is the technique most commonly used to treat non-displaced fractures of the mandible. It is commonly known as “wiring the jaw shut.” This process involves Figure 2. Diagram showing the locations and frequency of mandible fractures6anchoring arch bars to the gums of the maxilla and the mandible. The arch bars are held in place by 24 gauge wires which are wrapped around the molars. Rubber bands or 26 gauge wires are then wrapped around loops extending from the arch bars, which connect the upper and


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UW-Madison BME 200 - Maxillomandibular Fixation

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