WIRING

TECHNIQUES IN
MAXILLOFACIAL
SURGERY
presented by
p.dinesh kumar. Mds
frcs

INDICATIONS FOR CLOSED REDUCTION

Non displaced and favourable fractures
grossly communited fractures
edentulous atrophic mandible
fractures in children
condylar fractures

CONTRA INDICATIONS

patients with poorly controlled seizures

patients with compromised pulmonary fn
patients with psychatric or neurological disorders

VARIOUS TYPES OF WIRING

DIRECT INTERDENTAL WIRING:
ESSIGS WIRING
GILMERS WIRING
RISDONS WIRING

INDIRECT INTERDENTAL WIRING

IVY LOOP OR EYELET WIRING
CONTINOUS OR MULTIPLE LOOP WIRING

ARCH BAR FIXATION

CIRCUM MANDIBULAR WIRING

PER ALVEOLAR WIRING

SUSPENSION WIRING
CIRCUM ZYGOMATIC WIRING
FRONTAL SUSPENSION
PIRIFORM APERTURE SUSPENSION
ZYGOMATIC BUTRESS SUSPENSION
INFRA ORBITAL SUSPENSION

DIRECT INTERDENTAL WIRING

ESSIGS WIRING
Used to stabilize dento alveolar fracture as well as it can

be used as anchoring device for IMF.

There should be sufficient number of teeth on either side

of the fracture line.

A 40 cm 26 guage prestretched stainless steel wire is

used.
The wire is passed interproximally between two teeth

present a little away from fracture line.

The wires are passed around the teeth in a figure of 8

manner until they reach 2 to 3 teeth away from the

fracture line.
Now the wires are passed without looping to the other

side of the fracture line and 2 to 3 teeth away from the

fracture line on the opposite side.
Again the wires are taken around 2 to 3 teeth in a figure

of 8 manner.
Now this acts as an arch bar on which the other smaller

wires are tightened to stabilize the fracture.

GILMERS WIRING
It is used for IMF.
Most common and simple method.
Few firm teeth in the mandible as well as in maxilla are

chosen.
At least one firm teeth must be chosen anterior and posterior

to the fracture line.

A pre stretched 20 cm long 26 guage wire is taken and passed

around the neck of the chosen tooth.

Both the ends of the wire are brought out on the buccal side

and twisted.

The same procedure is carried out for all the chosen teeth

in the individual arches.

Then the mandibular wires are twisted tightly with the

corresponding maxillary wires.The ends are cut short and

sharp ends are tucked in.
The main disadvantage of this wiring is that there may be

extrusion of the teeth as excess load is applied.

Another disadvantage is of requiring complete removal of

the wires to open the mouth in emergency situations.

RISDONS WIRING
It is commonly used method of horizontal wire fixation.
This can be a substitute technique for arch bar.
In this method second molars are usually chosen for

anchorage on either side.

A 25 cm long 26 guage wire is passed around the neck of

second molar on each side and both the ends are brought in
buccal side.

The ends are twisted for entire length thus forming a

strong base wire that comes towards the midline from each
second molars.
Two base wires are grasped and twisted at mid line and

adapted to the necks of the teeth on the buccal side .

This base wire is secured to individual teeth by using

additional interdental wires.

This type of horizontal wiring offers strong fixation.

IVY EYELET WIRING

The Ivy loop embraces the two adjacent teeth.one or two Ivy

eyelets should be placed in each quadrant.

A 26 guage stainless steel wires cut in 20 cm lengths are used.
A loop is formed in center of wire around the beak of a towel clip

or shank of dental bur and twisted thrice with two tail ends. Such
Ivy loops can be preformed and stored in cold sterilizing solution
for emergency use.
The two tail ends of the eyelet are passed through the interdental

space of the selected two teeth from buccal to lingual side.

One end of the wire is passed around the distal tooth lingually

and brought out from the distal interdental space over the buccal
side and threaded through the previously formed loop.

The other wire tail end is carried around the lingual surface

of the mesial tooth and brought out on the buccal surface

from the mesial interdental space, where it meets the first tail
end wire.
The two wires are crossed and twisted together and the loop

is adjusted and bend towards gingiva.

The mandibular wire eyelets can be secured to maxillary

eyelets by joining wires.

Advantage is that bridging wires can be removed whenever

required without disturbing the main wiring.

Even when there is breakage of wire during fixation only that

eyelet can be removed and replaced.

HALLAM MODIFICATION ( 1945 )

WILLIAM MODIFICATION ( 1968 )

CLOVE HITCH METHOD

STOUTS MULTI LOOP WIRING

The posterior part of four quadrants are used for wiring.
4 pieces of 26 guage 20 cm long wires are required and

piece of solder is used for making loops.

The piece of solder wire is adapted to buccal surface of

teeth.
The 20 cm long pre stretched wire is folded into two parts,

one part acts as the stationary wire and the other end is
brought distal to the second molar and taken around it on
lingual side.

This working end is threaded through the mesial side of

second molar to the buccal side under the solder wire.

It is then looped around the stationary wire and solder

wire and back into the interdental space from buccal to

lingual. The same procedure is repeated for each tooth up
to midline.
The solder wire is removed after the loops are formed and

the loops are twisted to form eyelets.

Finally the stationary and working ends of the wires are

twisted together.

ARCH BAR FIXATION

The arch bar is a flat, sturdy stainless steel bar on which

fleats or hooks are attached.

It is a effective, quick and inexpensive method of fixation.
The different types of arch bars are,

pre fabricated
custom made
acrylated arch bars
directly bonded arch bars
Of these the most commonly used are the pre fabricated

Erich arch bars.

CUSTOM MADE
BAR

ACRYLATED ARCH

The arch bar is measured to fit from first molar to first

molar.
The arch bar is placed in such a way that the fleats or

hooks face towards the gingival margin.

Now 15 cm of 26 guage wire is taken and starting from

the distal tooth, the wire is passed from buccal to lingual

side below the arch bar and from lingual to buccal above
the arch bar and twisted together.
This is continued for all the teeth and the arch bar is

secured.
When placing an arch bar across a displaced fracture

segment,it is cut at the fracture site and placed seperately.

PER ALVEOLAR WIRING

Two peralveolar wires are placed in the canine region on
either side for fitting patients own denture to alveolar ridge.
The splint is firmly placed in the position in the upper jaw.

A kelsey-Fry bone awl introducer is pushed from

buccal to palatal aspect.
A 26 guage wire is thresded through the eye and the wire is

withdrawn with it the wire on the buccal surface.

Same procedure is repeated on opposite side and then the

splint is replaced in the mouth and wires adjusted over it and

twisted over the grooves and the ends tucked inwards.

CIRCUMMANDIBULAR WIRING
OBWEGESERS PROCEDURE
It is used for fixation of lateral compression splint to the

mandibular bone.
Lower border of mandible is palpated in the canine region and

the skin is pierced beneath the lower border of the mandible by

Kelsey-Fry bone awl and it emerges through the floor of mouth.
A 26 or 28 guage wire is inserted through the eye of the awl and

the awl is withdrawn till the lower border and directed upward
along the buccal surface of mandible to pierce through the buccal
sulcus.
The two ends of the wire are adjusted and the splint is adjusted

and the lingual and buccal wires are held together and twisted in
the region of canine grooves, cut and finished inward.

SUSPENSION WIRING

FRONTAL SUSPENSION
It is used for fracture of maxilla at the Le Fort II or III level

Arch bar is secured in the upper and lower arch

The frontozygomatic region is exposed with a small lateral

eyebrow incision.
A hole is drilled in the zygomatic process of frontal bone which

is 5mm above the frontozygomatic suture.

A pre stretched 26 gauge SS wire is passed through this hole

and bent back so that an equal length protrudes on either side of

this bur hole.
The two ends of wire are threaded through the eye of Rowes

zygomatic awl and crimped.

The awl is then passed downwards and forwards behind the

frontal process of the zygomatic bone deep to the zygomatic

arch to pierce through the oral mucosa in the upper buccal
sulcus in the region of upper molar teeth.
The wire ends are detached from the awl and secured nwith an

artery forceps while the awlm is withdrawn. These wire ends are
to be secured on arch bar.
A small SS wire which is threaded beneath the suspension wire

and the passes through the bone and is twisted is called Pull-out
wire. This wire negotiates the making of incision again to expose
the wire.
Suspension wires are placed on both sides for uniform

suspension and occlusion is checked and the wire is then

secured to the arch bar

CIRCUMZYGOMATIC WIRING
It is used for fixing a Le Fort I fracture.
The point of suspension is in the region of junction between

the frontal and temporal process of the zygomatic bone.

An awl is introduced either directly through the skin or

through a small stab incision made in that region.

The awl pierces the temporal fascia and passes medial to

the zygomatic bone and zygomatic buttress to pierce the

buccal sulcus in the region of first molar.

A pre stretched 26 gauge SS wire is then attached to the

eye of the awl and crimped.

The awl is withdrawn just above the zygomatic arch and

reinserted this time lateral to the zygomatic bone and

directed downwards and forwards to emerge through buccal
sulcus. This makes wire loop around zygomatic bone.
The wire ends are secured and adjusted so as they rest on

zygomatic bone.
The ends of the wire are then secured to the arch bar.

PIRIFORM APERTURE SUSPENSION

This can again be used for the fixation of a Lefort I fracture

as the piriform aperture is a stable bone present above the

level of the fracture level.
The piriform aperture is exposed by an intraoral incision

and a hole is drilled.

Wire is threaded through this hole and then attached to

the arch bar.

ADVANTAGES OF CLOSED REDUCTION

more conservative procedure
No complications associated with surgery is present
Can be done in medically compromised patients

DISADVANTAGES
airway compromise due to IMF
Loss of function of tissues
decreased nutritional status of patients

 only occlusion is taken as a guide

Difficulty in speech
Social inconvinience

EFFECTS OF PROLONGED IMF

Formation of adhesions in joint
Thinning and necrosis of articular cartilage
Osteoporosis of bone due to disuse
Atrophy and weakening of muscles due to disuse

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