• Users Online: 228
  • Print this page
  • Email this page


 
 Table of Contents  
TECHNICAL NOTE
Year : 2020  |  Volume : 14  |  Issue : 2  |  Page : 101-102

Role of anchor screw in the management of mandibular condylar fracture


1 Commandant and Command Dental Advisor, CMDC (SC), Pune, Maharashtra, India
2 Commandant, AFDC, New Delhi, India

Date of Submission08-Apr-2020
Date of Acceptance11-May-2020
Date of Web Publication15-Jul-2020

Correspondence Address:
N K Sahoo
CMDC (SC), Pune, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JODD.JODD_20_20

Rights and Permissions
  Abstract 


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

How to cite this URL:
Sahoo N K, Roy I D. Role of anchor screw in the management of mandibular condylar fracture. J Dent Def Sect. [serial online] 2020 [cited 2020 Aug 5];14:101-2. Available from: http://www.journaldds.org/text.asp?2020/14/2/101/289748



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.
Figure 1: Traction applied through the wire engaged to anchor screw

Click here to view


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.
Figure 2: Postoperative radiograph showing position of anchor screw

Click here to view


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Article Figures

 Article Access Statistics
    Viewed84    
    Printed4    
    Emailed0    
    PDF Downloaded12    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]