Sagacity of surgical selectivity: a retrospective analysis of occlusal outcome and intermaxillary fixation use in midface fracture fixation

Abstract

Advances in surgical techniques and materials have improved midface fracture management, with miniplate fixation replacing traditional intermaxillary fixation (IMF). This study evaluates whether IMF remains necessary, focusing on postoperative malocclusion and the impact of fracture complexity, demographics, and operative techniques on patient outcomes. A retrospective observational analysis of 100 midface trauma cases requiring surgical fixation was conducted at a major trauma centre in London. Patient demographics, injury parameters, and operative details, including IMF use, were assessed. Statistical analysis was performed to evaluate associations between fracture complexity, operative factors, and postoperative malocclusion. Postoperative malocclusion was documented in 8% of cases, with IMF usage showing a statistically significant association with malocclusion (p = 0.027). However, fracture complexity and injury patterns were not significant predictors of occlusal outcomes. IMF was primarily used in more complex cases, often involving a higher number of fractured buttresses requiring fixation. Our study shows that accurate anatomical reduction and fixation of complex midface fractures ensures predictable functional and aesthetic outcomes. Intermaxillary fixation (IMF) remains an essential tool in supporting the reconstruction of deranged occlusion in midface trauma. While useful as an adjunct, our findings suggest that IMF is not always necessary in less complex cases, and its use should be considered judiciously, as a very low rate of postoperative malocclusion can be achieved with more selective application.Copyright © 2025