We read with interest the article entitled “Stryker SMARTLock Hybrid Maxillomandibular Fixation System: Clinical Application, Complications, and Radiographic Findings.”1 We must disclose at the outset that Dr. Marcus owns the intellectual property associated with this technology, which is licensed to the Stryker Corporation (Kalamazoo, Mich.). In the article, Kendrick et al. touched on the very issues that were pertinent in designing the device and method in Table 1. It was gratifying to see in their study that they were able to demonstrate achievement of these goals, particularly in terms of the efficacy and cost effectiveness of the device. They were also able to demonstrate some of the problems that have been encountered, namely, mucosal overgrowth, irritation, and dental injury. Fortunately, despite the use of seven screws per arch for a total of 14 screws per patient, only one instance occurred in which endodontic treatment was necessary to treat a dental injury. We agree with them that probably fewer screws are required to achieve the same efficacy, which would thereby further reduce the operative time and the risk.
We would be interested in their response to one aspect. It seems that there is a learning curve associated with use of the system. Although we encountered the same issues that they presented in our early use of the device, we have seen far fewer of these concerns over the past 12 months. This would include mucosal overgrowth, encroachment on the teeth, and irritation. The patients in their series were treated by third- and fourth-year residents within their department. Given this, and taking into consideration the learning curve that we have experienced as senior surgeons, their results are that much more impressive. The device became available in 2013, which coincides with the beginning of their study period ending in 2014. We are curious whether their group’s experience over the subsequent year has been different. In addition, a lower profile, shorter arch bar was made available in 2014, and we have noticed that its use has led to a decrease in the incidence of mucosal overgrowth. We would be interested to see whether their experiences are similar. Once again, disclosures notwithstanding, we commend them for their work.
Dr. Marcus receives royalties from Stryker, Inc., for the license of intellectual property associated with the Stryker SMARTLock Hybrid Maxillomandibular Fixation System. Dr. Powers has no financial interest to report in relation to the content of this communication.
Jeffrey R. Marcus, M.D.
David Powers, M.D., D.M.D.
Division of Plastic, Maxillofacial, and Oral Surgery
Duke University Hospital & Children’s Health Center
1. Kendrick DE, Park CM, Fa JM, Barber JS, Indresano AT. Stryker SMARTLock hybrid maxillomandibular fixation system: Clinical application, complications, and radiographic findings. Plast Reconstr Surg. 2016;137:142e150e.
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