Hybrid Arch Bars (Stryker)

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Preoperative Considerations


  • Tooth injury
  • Gingival overgrowth
  • Infection
  • Screw loosening and avulsion


  • Local, sedation, or GA


  • None


  • Local anesthesia
  • Hybrid arch bar set
  • Screws
  • Hand or power driver
  • 24g wire or elastics
  • Cheek retractors


  • Before starting, evaluate fracture pattern, dental, periodontal health to ensure the case is appropriate for hybrid arch bars vs Erich
Mandible fracture between #22 & #23
  • Begin by nerve blocks or infiltration (aids hemostasis) to all buccal tissues
  • If patient is awake, can use 30g needlefor comfort
Local anesthesia administered
  • 6mm vs 8mm screws can be chosen based on anatomy (soft tissue thickness, bony anatomy on scan, etc.)
Power driver
Screw loaded
Screw stabilized by sliding sheath downwards
Maxillary arch bar adapted
Fixation of screw
Spacer is placed to prevent undue soft tissue compression
Screw hole can be bent to avoid tooth roots
Screw placed into intra-radicular space

Completed maxillary arch bar
Mandible digitally reduced and arch bar adapted
Screw hole removed over fracture line
Mandibular arch bar complete
24g wire used for MMF
Rosettes for comfort
Completed hybrid MMF

Postoperative Considerations


  • Reinforce liquid diet
  • Reinforce oral hygiene

Follow Up:

  • Monitor for screw loosening
  • Reinforce liquid diet
  • Reinforce oral hygiene

Operative Note

Surgeon(s): ***

Assistant Surgeon(s):  ***

Preoperative Diagnosis: ***

Postoperative Diagnosis: Same

Procedure(s): ***

Anesthesia: General

Implants: None


Drains: None

Fluids: See anesthesia record

EBL: Minimal

Complications: None

Counts:  Correct x2

Indications: ​***

Findings: As expected

Procedure in Detail:

The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

Attention was directed to the maxilla. An appropriate sized arch bar was selected and adapted. The arch bar was fixated to the maxilla with screws taking care to ensure adequate distance from dental roots. Another arch bar was fixated to the mandible in a similar fashion. The posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. 24g wire was then used to place the patient into maxillomandibular fixation.

The patient's face was then cleaned and tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.


  • 21440 Closed treatment of alveolar ridge fractures
  • D7620- Maxilla- closed reduction (teeth immobilized if present)
  • D7640-Mandible- closed reduction (teeth immobilized if present)
  • D7771- Alveolus, closed reduction stabilization of teeth
  • 21453/D7640 Closed treatment of mandible fracture with interdental fixation
  • 21421/D7620 Closed treatment of maxilla or palate with interdental fixation