Predictors of intermaxillary fixation (IMF) after open reduction and internal fixation (ORIF) in maxillofacial fractures: A retrospective cohort study

Introduction: Open reduction and internal fixation (ORIF) has several advantages over closed treatment modalities of maxillofacial fracture by offering an early return to function and better patient acceptance. The goal is to achieve good occlusion without placing the patient in maxillomandibular fixation (MMF). Nevertheless, there are certain situations when MMF becomes imperative in the postoperative period, even after ORIF. This study aims to identify the factors responsible for MMF following open reduction and internal fixation of maxillofacial fractures. Materials and Method: Maxillofacial trauma patients with fractures involving the dentoalveolar component and treated by ORIF were included in the study. The following data were collected: age, sex, etiology of injury, fracture pattern, associated mandible fractures, delay in the surgical intervention, and need and duration for postoperative IMF. Statistical analyses were performed with the Chi-Square test, and for the inter-category association, the 2 proportion Z-test was used. Result: 106 patients with maxillofacial fractures treated by ORIF between July 2018 and June 2023 were included in the study (97 male and 9 female). Patients were categorized into three groups. Group A included midface fracture with associated mandible fracture (n = 30), Group B included isolated midface fracture (n = 30), and Group C included isolated mandible fracture (n = 46). The requirement for IMF was significantly associated with fracture pattern in both Group A and Group B, with a P value of 0.03 and 0.004, respectively. In Group C, IMF is dependent on the type of osteosynthesis P value < 0.001. There was a significant association between the need for IMF and delay in the surgery ( P < 0.001). Conclusion: The study demonstrated that in pan-facial fractures, midface fractures accompanied by mandible fractures, and cases where surgical intervention is delayed by more than a week, supplementary intermaxillary fixation (IMF) may be required even after adequate osteosynthesis.