“Always double glove for facial trauma cases.” This is a well-known mantra at teaching hospitals and level 1 trauma centers. “Why?” one might ask. It’s because facial trauma commonly requires wires to stabilize the jaw and align the teeth and the wires pose a serious sharps injury risk.
Sharps injuries include needle, scalpel, and wire penetration injuries to the skin. These injuries can pose a risk of exposure to hepatitis C or HIV. Wearing an additional surgical glove on each hand, in theory, can decrease the chance of disease transmission. Despite this risk, wire-based surgical techniques have been the mainstay for the greater part of the last century for jaw fracture surgery.
Enter Minne Ties Agile MMF, the recently FDA-cleared “zip-tie” style devices used to immobilize the jaw and place the teeth into occlusion. These blunt-tipped devices have been shown to effectively hold a patient’s teeth into occlusion, termed maxillo-mandibular fixation (MMF), while replacing the need for wires.
The devices are designed to thread between the teeth within the apical embrasure, the triangular space between teeth where a toothpick will wedge. As the devices come in a selection of sizes (1.0, 0.7, and 0.5 mm diameter) to snugly fit within this tight space, the devices can firmly grab the dentition and “zip-tie” a patient’s teeth into occlusion regardless of how tightly-spaced a patient’s teeth are.
The devices can be used to stabilize the teeth for fractures managed without internal fixation or in conjunction with titanium plates for internal fixation. FDA clearance occurred in 2017 for Minne Ties Agile MMF for the indication of maxilla-mandibular fixation.
In addition to sharps injury mitigation, the devices are designed to offer multiple efficiencies including quick application in the operating room or clinic, minimally invasive application, and simple removal. They have been shown to achieve MMF on the order of 12-15 minutes in the OR.
Clinic or emergency room application is also possible in non-displaced fractures. As the devices thread through the apical embrasure, they can simply displace the apical papilla (the triangle of pink tissue between teeth), which minimizes soft tissue trauma Lastly, because Minne Ties are effectively a polymer-coated suture, they can be cut and removed with a simple suture scissors making clinic-based removal or patient administered release easy and straightforward.
Minne Ties threaten to disrupt mandible and maxilla fracture management because of these efficiencies, but more importantly, because of the decreased tissue trauma and pain suffered by patients. Wire and screw-based techniques to manage fractures invariably cause soft tissue trauma to the gums around the teeth, but also to the opposing/adjacent oral mucosa of the lips and cheeks.
Whereas the metal of these techniques abrades the soft tissues of the mouth, the smooth plastic and polymer surfaces of Minne Ties are designed to be much less abrasive. Patients treated with Minne Ties won’t suffer wire-based trauma from their treatment. Further, OR surgeons and staff can avoid the sharps injury risk so common in prior decades.
The age-old mantra to “always double glove for facial trauma” may be disrupted too.
Alan W. Johnson, MD, MS is a board-certified Otolaryngologist – Head & Neck Surgeon. As a fellow in the Earl E. Bakken Medical Devices Center Innovation Program, he invented dental occlusion ties (brand name: Minne Ties) in 2013.