Screw and Wire-Assisted Reduction of Lingually Displaced Bilateral Parasymphysis Fracture: A Technical Modification With Case Presentation

Lingually displaced bilateral parasymphysis fractures pose a significant challenge because of the instability of the intermediate mandibular segment and the difficulty in achieving adequate three-dimensional control during reduction. We describe a simple screw and wire-assisted reduction technique modification using an intermaxillary fixation (IMF) screw as a temporary skeletal traction device. Following exposure of the fracture sites, an IMF screw preloaded with stainless-steel wire was inserted at the midpoint of the chin into the labial cortex of the intermediate fragment. The attached wire provided a controlled traction handle, allowing outward, upward, and rotational manipulation of the lingually displaced segment into anatomical alignment. Temporary intermaxillary fixation was maintained to guide and preserve the pre-traumatic occlusal relationship. Bilateral Ellis maneuvers were subsequently performed to counteract lingual splaying and gonial flaring. Following clinical confirmation of reduction, definitive fixation was achieved using 3D titanium plates, after which the IMF screw and wire were removed. This technique modification is simple, cost-effective, reproducible, and facilitates controlled reduction while minimizing soft tissue manipulation.