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National Journal of Maxillofacial Surgery
 
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Table of Contents
TECHNICAL NOTE
Year : 2022  |  Volume : 13  |  Issue : 4  |  Page : 237-238  

Double bridle wire technique: A better alternative for mandibular fracture stabilization


Department of Oral and Maxillofacial Surgery, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India

Date of Submission11-Dec-2017
Date of Acceptance24-May-2022
Date of Web Publication20-Aug-2022

Correspondence Address:
Dr. Neha Jajodia
Department of Oral and Maxillofacial Surgery, PGIDS, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njms.NJMS_77_17

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How to cite this article:
Jajodia N, Singh V. Double bridle wire technique: A better alternative for mandibular fracture stabilization. Natl J Maxillofac Surg 2022;13, Suppl S1:237-8

How to cite this URL:
Jajodia N, Singh V. Double bridle wire technique: A better alternative for mandibular fracture stabilization. Natl J Maxillofac Surg [serial online] 2022 [cited 2022 Oct 5];13, Suppl S1:237-8. Available from: https://www.njms.in/text.asp?2022/13/4/237/353960



The first documented evidence of splinting teeth to stabilize mandibular fractures dates back to the Greco–Roman period. Bridle wires then, were made of gold/linen threads.[1] The original technique as described by Hippocrates involved placement of a single wire around the teeth adjacent to the fracture, which is followed till date.

The technique is a temporary 'first aid' measure aimed at stabilizing the fracture ends by passing a circumdental pre-stretched 26 gauge wire around the necks of one or two teeth on either side of the fracture. Maintaining manual reduction at the alveolus level, the wire ends are twisted and tightened in a clockwise manner to attain stability. This helps alleviate pain due to fracture movement, gives support and protects from further soft tissue damage and muscle cramping.[2] It helps assist in open reduction and internal fixation (ORIF) of mandible fractures by holding the fracture in a reduced position during fixation.[3]

Clinically, loosening of the single bridle wires is often noted and can lead to errors in fixation or patient discomfort due to fracture mobility.

A double bridle wire technique can provide better stability and maintenance in the reduced position for mandibular fractures. Similar to a single circumdental wire, two wires are passed around one or two teeth adjacent to the fracture site. The operator while maintaining reduction with one hand, tightens one of the wires by pulling it to one direction away from fracture end (similar to a single wire technique). Subsequently, he pulls and tightens the other wire in the opposite direction, again away from the fracture site. Both the wires are equally tightened to maintain minimum force on the fracture site. After equal tightening of both the bridle/tie wires, the twisted ends are cut and turned clockwise to form a small loop so that the buccal gingiva is not damaged [Figure 1] and [Figure 2].
Figure 1: Fracture before reduction

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Figure 2: Fracture stabilized with double bridle wires

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In single mandibular fractures this technique can help reinforce stability of the reduction and can sometimes eliminate the need for arch bars.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Miloro M, Ghali G, Larsen P, Waite P. Peterson's Principles of Oral and Maxillofacial Surgery. 2nd ed. Shelton, CT.: People's Medical Pub. House-USA; 2012.  Back to cited text no. 1
    
2.
Fonseca RJ, Walker RV, Barber HD, Powers MP, Frost DE, editors. Oral and Maxillofacial Trauma. 4th ed. St Louis: Elsevier; 2013.  Back to cited text no. 2
    
3.
Mitchell DA, Kanatas AS. An Introduction to Oral and Maxillofacial Surgery. 2nd ed. Boca Raton: CRC Press; 2014.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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