Purpose: Maxillomandibular fixation (MMF) is an imperfect method to secure the occlusion in simple mandible fractures. MMF increase operative time (application and removal) and places the surgeon at risk of blood borne disease transmission. We propose a novel technique whereby intra-operative use of a mini external fixator provides temporary rigid fixation of the fracture in reduction and allows dynamic occlusal assessment followed by permanent mini-plate fixation, while obviating the need for MMF.  

Methods: A single surgeon consecutive case series of 10 non-comminuted mandible fractures treated with temporary intra-operative mini external fixation followed by permanent mini-plate fixation without the use of MMF is presented.

Contraindications for temporary external fixation technique were defined as: 1. Patients with other injuries requiring application of MMF or 2. Patient refusal of the technique during informed consent.

Intra-oral incisions are used to expose and debride the fracture. Subsequently, 2mm pins for the external fixation device are placed percutaneously proximal and distal to the fracture site.  Fragments are then manipulated into anatomic reduction and the external fixator secured. A detailed, dynamic occlusal assessment is performed as well as examination of the fracture site for anatomic reduction.  If pre-morbid occlusion has been restored and anatomic reduction achieved then final rigid mini-plate fixation is applied and the external fixator removed.  Postoperative CT scans were performed on all patients to evaluate reduction. 

Results: The temporary intra-operative external fixation technique was successful in establishing a stable maximal intercuspal position (MIP) without prematurity, open bites, or new cross bites in all patients. Pre-morbid occlusion was accomplished in 100% of patients as determined by post-operative clinical evaluation. No patient required revision of fixation for malreduction and/or malocclusion. Postoperative CT scans performed on all patients showed excellent fracture reduction. 

Conclusion: The temporary intra-operative external fixation technique offers several benefits over the traditional use of MMF to establish premorbid occlusion: 1. Elimination of MMF shortens the procedure 2. Risk of puncture injury from wires is eliminated   

3. Temporary intra operative external fixation allows the dynamic evaluation of intercuspation, excursive relations, and protrusive relations before fixation 4. Iatrogenic lingual-tilt in the coronal plane and lingual-splay in the axial plane caused by MMF is avoided. Finally, our technique is suitable for practitioners of all experience levels, since if a pre-morbid occlusal relationship is not easily obtained using the external fixator subsequent conversion to an MMF-established occlusal relationship is simple, although we have not encountered this problem.