Patient Case Report Intraoperative MMF With Minne Ties Agile MMF During Open Reduction Internal Fixation of a Bilateral Mandible Fracture Mark Oppenheim D.M.D, M.D.
A 22-year-old female presented to the University of Louisville Hospital Emergency Department after being assaulted and sustained isolated bilateral mandible fractures but no other injuries. Minne Ties were a viable option for intra-operative MMF due to the patient’s good dentition, and were chosen over other MMF methods based on less time to apply and remove, reduced trauma to the dentition and ease of application. Three large (18ga) Minne Ties were placed on the right side, posterior to anterior, two large were placed on the left side, and one large was placed between her central incisors. The patient came into occlusion well; complete application of the devices took approximately 5 minutes.
The right parasymphysis fracture was first fixated by placing a 2.5 mm locking reconstruction plate on the inferior border. With satisfactory anatomic reduction and occlusion, a 1.5 mm lateral border plate was placed on the left angle fracture. The Minne Ties were then removed, which took less than one minute. The patient demonstrated pre-morbid occlusion and adequate healing during her 2-week follow-up visit.
With a total application time of five minutes and removal time of one minute, Minne Ties significantly reduced total operative time, were minimally traumatic to the patient’s dentition and gingiva, reduced the risk of wire stick injuries for the providers and surgical staff, and produced strong and stable MMF and occlusion throughout the case, resulting in an excellent surgical outcome.
Risk of Glove Puncture and Wire Stick Injury
"Last Tuesday I got stuck with a wire right through my finger...it's happened to everyone. It happens to me at least once or twice a year with arch bars. But, of course, no one reports it." Oral & Maxillofacial Surgeon
The International Safety Center (ISC) released a consensus statement on sharps safety in 2020. The following statement was published by the ACS in 2020 referencing the new consensus statement:
The number of sharps injuries incurred by health care workers in the U.S. and subsequent exposure to bloodborne pathogens decreased significantly since the revision of the Occupational Safety and Health Administration's Bloodborne Pathogens Standard and the passage of the Needlestick Safety and Prevention Act in the early 2000s. However, the notable decrease in sharps injuries in that first decade slowed in the 2010s. In response to the enduring need to further decrease sharps injuries, the International Safety Center last year released a consensus statement, Moving the Sharps Safety in Healthcare Agenda Forward in the United States: 2020 Consensus Statement and Call to Action.
According to the statement's executive summary, the document "provides data on rates of injury and circumstances surrounding sharps injuries, outlines the requirements of the OSHA Bloodborne Pathogens Standard, lists facility-based measures and controls for prevention of injury and exposure, and provides policy-based recommendations to protect healthcare workers today and into the future." The unique challenges of sharps injury prevention in ORs and surgical settings also are specifically discussed.
Access the full ISC publication: Moving the Sharps Safety in Healthcare Agenda Forward in the United States: 2020 Consensus Statement and Call to Action.
An OMS-specific published study capturing data on wire sticks comes from the British Journal of Oral and Maxillofacial Surgery.
From the Journals "Incidence and patterns of needlestick injuries during intermaxillary fixation"
In an article in the 3rd 2011 edition of the British Journal of Oral and Maxillo Facial Surgery, R Bali et al. analyzed the incidence and patterns of needlestick injuries sustained during the application of MMF at DAV Dental College. The authors studied the incidence of needlestick injuries by surveying 12 residents of the Department of Maxillofacial Surgery who completed 172 MMF procedures over the course of a year. They found that there was a 23% risk of a needlestick injury in a given surgery (40 surgeries had needlestick injuries). The authors also found that nighttime surgeries had a much higher incidence (45%) than daytime surgeries (18%). The authors conclude, "as no barriers can eliminate percutaneous injuries, wherever possible the surgeon should explore the possibility of modifying or avoiding conventional IMF. The findings of this study could possibly increase awareness and reduce the occupational risks from sharps injuries during IMF".
Tips From The Minne Ties Training Video
A short tail about an inch long can be left for intraoperative use, allowing for additional tightening if needed.
For closed treatment, cut the suture as close to the clasp head as possible so it is flush and smooth, maximizing patient comfort. Using a blade works very well. Note: you will not be able to tighten after this step.
In Case You Missed It
Previously Dr. Alan Johnson and Dr. Larry Wolford provided a Zoom lecture titled:
Advances in Maxillomandibular Fixation (MMF). Please click here to view their full presentations
Recent Events
Invisian Medical was happy to attend the Special Operations Medical Association 2022 Scientific Assembly from May 2-6 in North Carolina!
Invisian Medical was also excited to support the Ohio Society of Oral and Maxillofacial Surgeons 2022 Annual Scientific Meeting on May 22nd at the Renaissance Columbus Westerville-Polaris Hotel in
Westerville, OH.
We enjoyed connecting with everyone and listening to the presentations!
Andrew C. Jenzer, DDS, Eisenhower Army Medical Center, presenting at the SOMS 2022 Scientific Assemble
Please Contact Invisian Medical For Clinical Support (913) 228-1857 | customerservice@minneties.com
As with most surgical procedures, there are risks associated with maxillomandibular fixation (MMF), including with Minne Ties. For complete information regarding indications for use, additional application and removal instructions, risks, contraindications, warnings, precautions and adverse events, please review the device’s Instructions for Use (IFU) included in the package and at www.minneties.com.
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