Computer Assisted Guided Placement of IMF Screws in Craniomaxillofacial Trauma: An Evolving Technique

Abstract

Intermaxillary fixation (IMF) screws have been introduced into maxillofacial trauma practice to reduce operation time and the complications associated with the placement of wire ligatures around teeth. Wires continue to be used to secure arch bars to teeth, form eyelets and long ligatures prior to putting a patient into maxillomandibular fixation (MMF). The application of wires to dental arches may result in sharp injuries to the operator, whereas injury to roots and nerves may arise from incorrect positioning of IMF screws in the jaws. The purpose of this technical note is to demonstrate how 3D patient specific (PS) surgical guides can be planned and fabricated to assist in the safe placement of IMF screws in the maxilla and mandible. It is proposed that PS IMF screw guides can be further developed to incorporate removable spoons and semi-circular access ports that not only facilitate safe screw placement but allow the guide to remain in position until all screw are secured. The potential benefits of PS IMF surgical guides include diminished risk of injury to facial structures and reduced operation time. The technique also lends itself to the placement of IMF screws via a robotic arm contributing to a safer operating environment for the maxillofacial surgery team.