Fourteen patients originally presented with hyperphagia and intractable morbid obesity have had maxillomandibular fixation (MMF) applied in an effort to control their obesity. In 10 patients who were massively obese or considered poor risk candidates for surgical control of their obesity, MMF was applied with the aim of reducing the obesity to a level where a surgical gastric restrictive bariatric procedure could be safely carried out. Eight of these patients had been rejected for surgical control of obesity elsewhere and two were edentulous. Five of these patients after successful weight loss over periods from 16 to 40 weeks (mean percentage overweight lost 84.8, range 39–150) safely underwent a gastric restrictive procedure. All five patients have had continuous weight loss after bariatric surgery. Two patients requested removal of MMF 1 and 2 weeks after application. The remaining three patients, who were candidates for surgery, after successful weight loss over periods from 12 to 28 weeks (mean percentage of overweight lost 45, range 38–50) decided not to proceed with surgical control. All have subsequently regained the lost weight. Four originally morbidly obese patients, who had had a previously successful gastric restrictive procedure followed by weight loss, requested MMF in an effort to lose further weight. Over periods from 8 to 16 weeks three of the four had further weight loss (mean percentage of overweight lost 18.3, range 5–30). After removal of MMF all four patients regained some weight. In only one was there a significant maintenance of weight lost during MME We conclude that MMF is a relatively simple, safe and effective procedure in producing weight loss in the morbidly obese. It can be successfully carried out on edentulous patients. Because of a high recidivism rate, it probably has no place as a single treatment modality. However, in an integrated approach to obesity management, it has a role, in particular in preparing giant and high surgical risk morbidly obese patients for a safe surgical procedure. When followed by a gastric restrictive operation, weight loss can be maintained and further weight loss anticipated. A period of pre‐operative MMF in selected high risk candidates for bariatric surgery may reduce the small but significant mortality and morbidity reported in most series of the increasingly popular gastric restrictive procedures.

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   |texte=   JAW WIRING IN THE TREATMENT OF MORBID OBESITY
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