Intermaxillary fixation: how practicable is emergency jaw release?

Intermaxillary fixation as part of management of facial fractures or following osteotomy for facial deformity presents unique problems to the anaesthetist. It is traditional practice to keep wire cutters available by the patient at all times to enable quick release of the jaws in emergency. The efficiency of release was tested by timing various members of the management team. The time taken to release the jaws was an average 35.3 seconds by experienced oral surgeons and an average 2 minutes 9 seconds by hospital staff involved in caring for these patients and was not a practical proposition for a lay person. Thus the value of releasing fixation is questionable in the initial care of obstruction or vomiting. Techniques of avoiding and managing these problems are discussed.