|Year : 2020 | Volume
| Issue : 2 | Page : 101-102
Role of anchor screw in the management of mandibular condylar fracture
NK Sahoo1, ID Roy2
1 Commandant and Command Dental Advisor, CMDC (SC), Pune, Maharashtra, India
2 Commandant, AFDC, New Delhi, India
|Date of Submission||08-Apr-2020|
|Date of Acceptance||11-May-2020|
|Date of Web Publication||15-Jul-2020|
N K Sahoo
CMDC (SC), Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Anchor screw is a bone screw engaged to bone and used to anchor wire ligature, sutures, and ligaments and to provide traction. In context of maxillofacial fractures, there is hardly any report of use of anchor screws.
Keywords: Anchor screw, mandibular condylar fracture, traction
|How to cite this article:|
Sahoo N K, Roy I D. Role of anchor screw in the management of mandibular condylar fracture. J Dent Def Sect. 2020;14:101-2
Anchor screw is a bone screw engaged to bone and used to anchor wire ligature, sutures, and ligaments and to provide traction. It is also used to engage the fractured segments through which segments are manipulated to facilitate reduction of long bones. In context of maxillofacial fractures, there is hardly any report of use of anchor screws.
Management of condylar/subcondylar fracture generates lots of interest among the clinicians regarding the method of treatment, closed versus open method. If open method, what should be the approach? Regardless of the approach, the accessibility to the fracture site is limited due to various anatomical factors. The problem is further compounded in case of long standing, displaced, and multiple fractures.
Anatomical reduction is the hallmark of fracture alignment which is held in position by stable fixation, thereby restoring the dental occlusion and condylar movements. Dental occlusion can be achieved by intermaxillary fixation (IMF) alone even without satisfactory reduction of fractured segments. The distal segment tends to telescope superiorly leaving inadequate space for the condylar (proximal) segment to be brought back to the anatomical position. Hence, there is a requirement of caudal traction of the distal segment along the long axis of the mandibular vertical ramus.
Traction on the distal segment can be applied by thumb pressure on the mandibular third molar area, but simultaneous IMF is not possible. More so, this traction is not along the long axis of the mandibular vertical ramus. To overcome this problem, we use a bone screw as an anchor screw directly engaged to the ramus for traction.
Method: Condylar fracture site is exposed under general anesthesia by any standard approach. Subperiosteal dissection is carried out along the lateral aspect of the ramus of the mandible. Elevation corresponding to mandibular foramen (antilingula) is identified to avoid damage to the inferior alveolar neurovascular bundle. A 1.6 mm diameter and 8 mm long drill bit is used to drill a hole in the ramus away from the zone of fixation under normal saline coolant. A titanium mini bone screw (2 mm diameter) of 10 mm length is engaged up to 7–8 mm. This screw is referred as anchor screw. A bone owl is passed through the skin from the submandibular area and brought out near the anchor screw. A prestretched 12 inch long 26 gauge stainless steel wire is taken. Both the ends of the wire engaged to bone owl and brought out when guiding the loop end to engage the anchor screw. The wire is twisted to prevent it from disengaging the screw.
Gradual and controlled traction is applied through the wire to pull down the distal segment along its long axis [Figure 1]. The condylar segment is manipulated and guided to its anatomical location. When maintaining the condylar position, the traction of the distal segment is released slowly so that the fractured ends contact with each other. IMF is done and stable fixation of fracture is carried out as per the standard protocol. IMF was released and condylar movements and dental occlusion were verified. The anchor screw and traction wire were removed, hemostasis was achieved, and wound was sutured.
Advantages: Fixation of anchor screw is carried out through the same surgical wound. It is least traumatic and does not require any additional armamentarium. It is strong and stable enough to sustained traction forces in any direction. It does not interfere in the surgical field and no hardware is left [Figure 2]. Similar traction can be applied by engaging a wire to the inferior border of mandible through a hole in case of submandibular or Risdon approach. The wire may cut through the bone.
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Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2]