Page 89 - 2022 Spring JSOM

Battlefield Management of Facial Fractures Using Minnie Ties

An Innovative Technique for Maxillomandibular Fixation

2
Joseph W. Ivory, DDS ; Andrew C. Jenzer, DDS *
1

ABSTRACT
Application of maxillomandibular fixation (MMF) for the where this technique focuses (Figure 1). Fractures to other
treatment of jaw fractures has a long history stretching back bony structures, like the skull, orbits, and nose, must be man-
thousands of years. Modern methods of MMF require exten- aged in a setting with a higher level of care (Figure 2), but
sive training for correct application and are often not practical immobilizing the maxilla and mandible, commonly called
to perform in a forward operating environment. Most MMF MMF is a critical skill. The purpose of this technique paper
methods carry inherent risks of sharps injuries and exposure is to describe and explain a new, easy, and safe technique to
to bloodborne pathogens. The authors present a method of accomplish MMF.
MMF with Minnie Ties, which are simple, effective, and much
safer than traditional methods of MMF. FIGURE 1 (LEFT) Reconstructed 3D CT scan demonstrating a right
mandibular displaced angle fracture.
Keywords: facial bones; facial injuries; mandible fractures; max- FIGURE 2 (RIGHT) Reconstructed 3D CT scan demonstrating a
illa fractures; jaw fractures; military dentistry; oral surgery complex panfacial fracture on a pediatric patient.

Introduction
Craniomaxillofacial (CMF) trauma represents a large amount
of trauma seen on the battlefield and in a wartime setting.
A large retrospective studying looking at all injuries between
2001 and 2007 to Servicemembers in support of Operation
Enduring Freedom and Operation Iraqi Freedom identified
2,014 CMF injuries out of the 7,770 battlefield injuries re-
ported to the Joint Theater Trauma Registry. Of the 2,014
1
CMF injuries, 27% were facial fractures. Numerous other Historical Context
1
studies have described the prevalence of facial injuries dating
back to World War II, with a historical average of 16–21% of The evolution of the treatment of mandibular fractures can be
battlefield injuries. The increasing incidence of CMF injuries traced through history, with the first mention of the treatment
2,3
is considered by many to be a result of higher survivability due of simple mandibular fractures in the Edwin Smith papyrus
6
to better equipment and armor, faster and improving medical dated around 1600 BC. Hippocrates, considered the father
care with decreased evacuation times, more effective trauma of modern medicine, seemed to be the first to recognize the
management techniques, and increased prevalence of impro- importance of immobilization to allow bones to heal. He ad-
vised explosive devices. 4,5 vocated wiring together adjacent teeth (the bridle wire tech-
nique) and the use of bandages to immobilize the jaw in 460
7
As the US military has transitioned to lower intensity conflicts AD. His approach was echoed by the Roman encyclopedist
over the last decade, and considering the operation scope of Celsus, who also instructed patients to stick to a liquid diet
Special Operations medicine, identification and stabilization and refrain from speech. Various cultures throughout the cen-
treatment of facial fractures are real and necessary skills for turies experimented with a combination of bandages and wires
the Special Operations Forces (SOF) medical provider. SOF to immobilize the fractured mandible, including the Sushruta
medical personnel are often required to treat traumatic inju- Samhita of India (500 AD) and the barbers of medieval Eu-
ries on local national, foreign military, and US national mili- rope, who essentially duplicated the technique of Hippocrates.
tary personnel with limited capability of evacuation to higher The 18th century saw the advent of the use of various splints
levels of care.
that were tied to the patient’s teeth, using the dentition to
When facial fractures occur, either as an isolated injury or in stabilize the bony segments. This was a departure from the
conjunction with other injuries, it is necessary to immobilize, principle of MMF articulated by Hippocrates and was met
and possibly temporarily reduce, these fractures. Fractures to with various degrees of success. The next major advancements
the bones of the jaws, namely the maxilla and mandible, are were seen in the 19th century, to include the precursor to the
*Correspondence to Andrew.c.jenzer.mil@mail.mil
1 Joseph W. Ivory is program director and Andrew C. Jenzer is assistant program director, Residency, Department of Oral and Maxillofacial
2
Surgery, Eisenhower Army Medical Center, Fort Gordon, GA.
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