Safety and efficacy of maxillomandibular fixation techniques: a network meta-analysis

Jaw fractures are prevalent facial injuries. Choosing the optimal intermaxillary/maxillomandibular fixation(IMF/MMF) technique is crucial for a successful conservative and surgical treatment, to achieve perfect occlusion.This network meta-analysis aimed to identify the most time-efficient and safe technique for IMF by comparing currently used techniques. A systematic search was performed in four databases, where 20,249 studies were identified; after the selection process 29 were included in the synthesis. Application time of IMF screws(IMFS)(MD -47,95% CI -62 to-33) and Hybrid Maxillomandibular Fixation(HMMF)(MD -33, 95% CI -48 to -19), and removal of IMFS (MD -16, 95% CI -23 to -8) were significantly shorter than Erich Arch Bar(EAB). EAB causes significantly fewer iatrogenic injuries than IMFS(OR: 0.30, 95% CI 0.09-0.93) or HMMF(OR 0.20, 95% CI 0.05-0.76). Both IMFS and HMMF were associated with a significantly lower risk of glove perforation and needlestick injury than EAB: OR 0.05(95% CI 0.02-0.12) and 0.08 (95% CI 0.03-0.23), respectively. In conclusion, IMF screws and HMMF are more effective than EAB in terms of application and removal time, oral hygiene, and patient acceptance. They also offer greater safety in terms of gloves and needlestick injuries, although there is a higher risk of iatrogenic injuries and hardware loosening.