Jaw wiring, formally known as Maxillomandibular Fixation (MMF), is a procedure used to stabilize the upper and lower jaws after significant trauma or corrective surgery. The technique acts like a cast, holding the bones perfectly aligned for a period, typically four to eight weeks, to promote healing. Patients often feel anxiety regarding the removal of the wires after this period of immobilization. This article provides a realistic overview of the procedure and the level of discomfort to expect.
The Mechanics of Jaw Wire Removal
MMF removal is an outpatient procedure, often taking place in the oral surgeon’s office. The fixation setup typically involves arch bars or bone-supported screws placed on the teeth, which are then connected by stainless steel wires or elastic bands. The goal of the removal is to disconnect the upper and lower jaws and free the mouth to open.
The procedure begins with the removal of the wires or elastic bands connecting the upper and lower arches. The surgeon uses specialized instruments, such as wire cutters and thin pliers, to clip the twisted wire loops. The jaw remains closed until all the intermaxillary connections are severed. Depending on the complexity of the initial wiring, the removal of the connecting material is often completed in under 30 minutes.
After the connecting wires are removed, the arch bars or fixation screws that were anchored to the teeth or bone may also be removed, depending on the patient’s healing progress. The arch bar removal involves unwinding or cutting the fine wires securing them to the individual teeth. At this point, the jaw is no longer immobilized, and the patient can begin to gently move their mouth.
The Sensation: Answering the Pain Question
The experience of wire removal is typically defined by intense pressure and discomfort rather than sharp, tissue-damaging pain. This is because the wires are secured only to dental structures and do not penetrate soft tissue or bone. The most acute sensations are felt around the teeth and gums where the hardware has been resting for several weeks.
Patients frequently report feeling a strong, tugging pressure as the wires are untwisted or slid out from around the teeth. This pressure results from the wires disengaging from the dental brackets and the surrounding gum tissue, which may have become slightly overgrown or inflamed. A surprising sensation for many is the sound and vibration of the metal being clipped or manipulated close to the inner ear.
Local anesthesia is rarely required for the wire removal itself since the wires are not embedded in sensitive tissue. However, the surgeon may recommend taking a dose of over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, about an hour before the appointment. This proactive measure helps mitigate potential soreness or inflammation of the gums caused by the pressure and manipulation of the hardware. The brief but intense pressure of the removal is a temporary discomfort, not a prolonged painful event.
Immediate Post-Removal Recovery and Discomfort
Immediately following the removal of the fixation hardware, patients commonly experience an odd feeling of freedom and an initial stiffness in the jaw muscles. The jaw joint and surrounding muscles have been immobilized for weeks, leading to muscle fatigue and a temporary inability to open the mouth widely. This stiffness is a direct result of the long period of non-use, not a complication of the removal process.
The areas where the arch bars or wires rested against the gums and inner cheeks may be irritated or slightly sore. This localized soreness typically subsides quickly, within 24 to 48 hours, as the soft tissues are no longer in contact with the metal hardware. Continuing with gentle salt water rinses can help soothe any minor abrasions or inflammation in the mouth.
The immediate focus after wire removal shifts to regaining full jaw mobility and strength. The surgeon will provide instructions for starting gentle jaw exercises to prevent long-term stiffness. The initial return to eating must be gradual, starting with soft foods that require minimal chewing. Patients should avoid chewing hard or tough foods immediately, as the jaw muscles need time to recondition and the bone needs final strength.