wire ligation interosseous fixation

Wire ligation and interosseous fixation for the treatment of mandibular fractures. Treatment of diseases: temporomandibular joint dislocation Indication Wire ligation and interosseous fixation is applicable to: 1. Complex fractures or multiple fractures, when the relationship between the dental arch and the splint is still abnormal, it needs to be cut open and the wire is ligated. 2. Displacement fracture of the posterior segment of the mandible (ascending branch). 3. edentulous jaw mandibular fracture. 4. Old fractures and occlusion. Contraindications 1. Mandibular fractures in childhood (6-12 years old) to avoid damage to permanent tooth germs in the jaw. 2. Comminuted fracture, before the fiber combination, excessive peeling of the periosteum, unfavorable healing. Surgical procedure 1. Extraoral route At the lower edge of the lower jaw 1.5 to 2 cm, the striate is an arc-shaped incision, and the skin, subcutaneous tissue and platysma are cut. The mandibular branch of the facial nerve is located under the platysma and the deep deep fascia, and from the facial artery. And in front of the vein surface, carefully protect and down the facial nerve, after ligation of the artery, vein, the upper edge of the incision is pulled up to the lower edge of the mandible, incision and peeling of the periosteum, revealing the lower surface of the lower jaw, pay attention to the periosteum should not Do too much peeling. 2. Intraoral approach More for toothless In the elderly patients, the periosteal incision was made on the alveolar ridge at the fracture end of the bone to reveal the surgical field of the bone fracture. 3. Fracture reduction Use the rongeur to clamp the two ends of the fracture segment and reset the displaced fracture segment. If the old fracture is misplaced, the bone knife should be used to re-cut, repair the epiphysis and reset it. 4. Pre-drilling bone hole In the lower 1/3 of the mandibular body, 0.5 to 1 cm from the outside of the fracture line, drill one or two bone holes, and pay attention to the direction of the ligature line perpendicularly intersecting the fracture line to prevent the displacement of the fracture piece; Be careful not to get close to the pupil plane to avoid damage to the root and inferior alveolar vascular bundle. If you use a high-speed electric drill when drilling, you must continue to drip with normal saline to avoid bone burns. 5. Wire fixing According to the horizontal and "8" shape cross-ligature, a soft stainless steel wire of 0.5 cm diameter was inserted into the bone hole, and the ligature was firmly ligated on the buccal side, and the wire stump was bent into a circle and buried in the drill hole. 6. Rinse the wound, layer suture, and place a drainage strip under the skin as needed to prevent hematoma, and appropriate bandage compression dressing.