Use of a Kirschner wire for skeletal anchorage

Abstract

A 17-year-old girl was diagnosed with a Class II malocclusion. Titanium screws were inserted into the maxilla for skeletal anchorage, but they loosened and the mucosa became inflamed during the orthodontic treatment because of the poor quality of the maxillary bone. The insertion of a metal plate failed to improve the anchorage for the same reason. We contemplated using the zygomatic bone for skeletal anchorage, and then the use of a Kirschner wire (K-wire) to supplement the anchorage. Kirschner wires have been used for the intramedullary fixation of long bones as well as for treating fractures of the zygoma and mandible.1 It is essential to maintain the proper path, depth, and position of the insertion when using K-wires, which requires that 0.9 mm K-wires are marked every 1 cm, and an electric drill, or suitable rotary hand-powered drill, and a metal tube (1.0 mm in diameter and 2 cm long) are to hand.

After the local anaesthetic had been given intraorally into the infrazygomatic area, a stab incision was made in the inferior aspect of the zygoma. This was undermined periosteally with a curette, and a metal tube 1 mm in diameter was positioned on the zygoma with appropriate angulation (Fig. 1). The K-wire was drilled through the flange, and inserted about 2 cm after being placed in contact with the zygomatic bone. After the wire had been inserted, it was sectioned with scissors, and the tube removed. The wire was then bent to the required position with three-jaw prong pliers, and a resin stop placed at the end of the wire (Fig. 2). The insertion of each wire took roughly 1 min. The stability of the wire was confirmed by palpation. The patient was assessed both clinically and radiographically (Fig. 3). The patient tolerated the procedure well, and there was no haemorrhage, laceration of the neurovascular system, or postoperative infection. After 6 months the wire was removed by twisting it with a wire holder, with no complications