Comparative Effectiveness of Arch Bar Techniques in Maxillomandibular Fixation for Midface Fractures: A Systematic Review and Meta-analysis

Abstract

Introduction: Midface fractures constitute a substantial portion of maxillofacial trauma and often require maxillomandibular fixation (MMF) for stabilization and occlusal realignment. While Erich Arch Bars (EABs) have traditionally been used for over a century, they are associated with prolonged operative times, increased glove perforation risks, and patient-related complications. Contemporary alternatives—including Hybrid Arch Bars (HABs), Screw-Retained Arch Bars (SRABs), and Embrasure Wires—offer promising advantages in surgical efficiency and safety. Methods: This PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD420251031357) compared EABs with modern MMF techniques. A total of eight comparative studies were included. Primary outcomes analyzed were operative time, glove perforation rate, complication rate, and fixation stability. Data were pooled using random-effects models, and study quality was assessed using the Newcastle-Ottawa Scale and Cochrane RoB 2 tool. Results: Alternative MMF systems significantly reduced operative time compared to EABs, with a pooled mean difference of −40 minutes (95% CI: −55 to −25). Glove perforation risk decreased by 52–75% with HABs, SRABs, and Embrasure Wires. Postoperative complication rates were similar across all systems, with no statistically significant differences. These findings remained consistent across subgroup and sensitivity analyses. Conclusion: HABs, SRABs, and Embrasure Wires provide effective alternatives to conventional EABs, offering improved surgical efficiency and reduced occupational risk without compromising clinical outcomes. Adoption of these newer systems may enhance operating room safety and performance, particularly in high-acuity trauma settings. Further multicenter trials with standardized outcome measures are recommended.