jaw wiring

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Jaw Wiring

 

Definition

Jaw wiring, also known as maxillomandibular fixation, is a surgical procedure where metal pins and wires are anchored into the jaw bones and surrounding tissues to keep the jaw from moving.

Purpose

Sports injuries, automobile accidents, falls, or fist-fights are a few of the situations where the jaw might be fractured or broken. In these cases, jaw wiring may be necessary to keep the bones aligned and stable while the jaw heals. The presence of cancer or other diseased tissues may make removal and reconstruction of the jaw necessary. Wiring the jaws shut has been used in the past as a weight loss aid in cases of extreme obesity where other treatments had failed, although this procedure is rarely used for that purpose today.

Precautions

Traumatic injuries to the face can cause damage to facial nerves and salivary glands and ducts. These injuries can also leave scars that may require additional surgery to correct.

Description

Jaw wiring surgery can be performed by an oral or maxillofacial surgeon (a specially trained dentist), or by an otolaryngologist (a doctor specializing in surgeries of the head and neck). The procedure may be done in a medical or dental office if the office is staffed and equipped to handle this type of surgery. More often, this surgery is performed in a hospital or medical center surgical area. If jaw wiring is required due to an injury, the surgeon may set the fracture immediately before swelling sets in. It is also possible to wait (up to several weeks) until the swelling goes down and some of the soft tissue injuries have healed, prior to wiring the jaw fracture.
The surgeon realigns the fractured bones. Every effort is made to restore the shape and appearance of the original jaw line. If any teeth were damaged, repair or replacement may be done at the same time. Small incisions may be made through the skin and surrounding tissue so the pins and wires can be set into the jawbone to hold the fracture together. To prevent the lower jaw from moving during healing, pins and wires may be inserted into the top jaw, as well. The upper and lower jaws are then wired together in order to stabilize the fracture.
As with other types of bone fractures, the jaw may take several weeks to heal. Another type of jaw immobilization that has been developed more recently, rigid fixation uses small metal plates and screws rather than pins and wires to secure the jaw bones. The main benefit of this technique is that the jaws do not have to be wired shut, allowing the patient to return to a more normal lifestyle sooner.

Preparation

X rays of the fractured area may be taken prior to surgery. Depending on the extent of the facial injury or condition to be corrected, the patient may receive a sedative for relaxation, a local anesthetic drug to numb the area, and/or an anesthetic agent to induce unconsciousness prior to the surgery.

Aftercare

A patient whose jaw has been wired will not be able to eat solid foods for several weeks. In order for the bone and surrounding tissues to heal, it is important to maintain adequate nutrition. A liquid diet that can be consumed through a straw, will be required. Soft, precooked foods can be liquefied in a blender, however, it may be difficult for the patient to consume adequate calories, protein, vitamins, and minerals with this type of diet. Liquid diet formulas may be a good alternative. The patient will also have to be taught how to care for the mouth, teeth, and injured area while the wires are in place.

Risks

It is possible that scarring may occur due to the need to make small incisions in the skin in order to insert the wires. With any surgical procedure, there are risks associated with the anesthetic drugs used and the possibility of infection. If there is a risk that the patient may vomit, the jaw wiring may pose a choking hazard. It may be recommended that wire cutters be kept available in case the wires need to be cut in an emergency situation.

Resources

Organizations

American Association of Oral & Maxillofacial Surgeons. 9700 West Bryn Mawr Avenue; Rosemont, IL 60018-5701; (847) 678-6200.
American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500. http://www.ada.org.

Other

"Know the Score on Facial Sports Injuries" The Virtual Hospital Page. University of Iowa. http://www.vh.org.
"Topic: Maxillofacial Trauma." Connecticut Maxillofacial Surgeons Page. http://www.cmsllc.com/toptrm.html.

Key terms

Oral and maxillofacial surgeon — A dentist who is trained to perform surgery to correct injuries, defects, or conditions of the mouth, teeth, jaws, and face.
Otolaryngologist — A doctor who is trained to treat injuries, defects, or conditions of the head and neck.
An extreme treatment for morbid obesity that utilizes the same methods and devices as those used for jaw fractures, allowing only the intake of liquids. The device is composed of orthodontic brackets attached to the teeth, and pliable wire wrapped either around or through the brackets. The brackets are optimally positioned with respect to the anteriorposterior position of the lower jaw. The wiring is configured to suspend the patient’s lower jaw in a semi-closed, partially movable resting position which permits a moderate amount of physiologic jaw movement and relatively clear speech, while inhibiting the ingestion of solid foods. While the technique is effective while the patient is ‘wired’, the patients usually regain the weight unless JW is combined with other methods—e.g., ileal bypass surgery.

jaw wiring

Obesity An extreme treatment of morbid obesity that utilizes the same methods and devices as those used for jaw fractures, allowing only the intake of liquids. See Gastric bubble, Ileal bypass surgery, Morbid obesity, Stomach stapling.

jaw wiring

The securing of the jaws in a proper relationship by means of malleable wire bound round the necks of the teeth. This is commonly done to splint single or multiple fractures of either jaw and is sometimes done to limit food intake in the treatment of severe obesity. Weight loss is rapid but old habits usually prevail when the wiring is removed.