 This 26-year-old soldier was shot in the right side of the face in action at Luzon. The facial injury included fracture of the mandible, comminuted, compound, region metal form on right side with considerable fragmentation of the bone. As a result, the two bone ends have failed to unite, and though the wound is healed, additional bone is required to bridge the gap and restore the contour of the mandible. Occlusion is poor and there is marked mobility at the side of fracture. X-rays show the space between the two ends of bone and indicate the need for bone replacement. A bone graft can be accomplished by using cast screw lock wing type sectional splints for fixation of fragments. The first step in the construction of the screw lock splint is to take an impression for a cast. Accurate impressions of the contour of the teeth are obtained with ordinary alginate compound, a plastic material prepared for the purpose in the usual manner. This step in the procedure follows standard practice. First, an impression is made of the upper teeth. Then a similar impression is made of the lower teeth with the same plastic. Though the lower jaw alone is affected by the injury, both casts are important, for one of the objectives of the procedure in this case is to restore occlusion. The impressions are poured with artificial stone using a vibrator or suction apparatus to assure uniform density of the models. Stone is used for the master models instead of plaster because of stone's greater hardness and density. Working models are obtained by duplicating the master models. Then the lower model is separated by sawing through the fracture line so the casts can be mounted on an articulator and the former occlusal relationship of the teeth obtained. Master models are kept intact for further duplication in case of inadvertent miscalculation. The separated portions are then reassembled in the original relationship of the lower teeth to the upper teeth. The facets of the teeth serve as guides. The gap in the lower jaw marks the site of the non-united fracture. Preliminary to actual casting, the models are assembled on an index base in the relationship previously established. As a precaution, the model is duplicated in refractory material before casting. Ordinary DP model reproducing material is used following standard practice to make the mold. The casting model is made of investment material. The waxing technique calls for the use of 18 gauge wax placed where the intermaxillary loops or hooks are to be formed. 18 gauge round or 14 gauge half round gold wire is used for the posterior hinges. Extensions of the wire are left to help keep them in place in the investment while the casting is being made. Carbon points are placed in the planned screw holes to make it easier to drill the casting before it is tapped. Lightning discs are used as separators at the points where the splint joints will be located. They are easily removed after the splint is cast. The casting ring with the waxed model invested in it is then placed in the furnace and baked for three hours at a temperature of 1175 degrees for gold and 1300 degrees for silver alloy. The ring is then placed in the centrifugal casting machine and molten metal forced into the mold to reproduce the wax in silver or gold. The rough casting is cleaned and brightened by pickling and muriatic acid. Then the casting is polished, sprues are cut, and excess removed with a carburetum wheel. The screw holes are drilled with the number 54, 364th drill. This is a painstaking step, for the splint may bend while the screw holes are being drilled. It is therefore important to hold the splint in accurate alignment and brace it well. The splint is then tapped where holes have been prepared for the screw lock and the interproximal retention screw. The holes can form in size to an 080 screw. Before reduction of the fracture begins, the patient is given morphine sulfate, 1 4th grain, and atropin, a 1 150th grain. 3rd division nerve block anesthesia is used when necessary. In this case, a hook type superior maxillary arch bar is used for traction or fixation during bone graft. A cast maxillary splint may be used. The maxillary arch bar is held in place with twisted wires. The splint for the lower jaw, now ready for insertion, provides firm reduction of the fracture while the bone graft is consolidating. Known as the cast wing type screw lock sectional splint, the device has, as its chief features, wing hinges on each end, a screw lock to provide retention, and additional screws to furnish interproximal retention. Either 080 or 3.48 screws may be used in the screw lock. Mechanical retention is added in the interproximal undercuts with 080 screws. The interproximal retention screw engaging the opposing tooth contacts aids contour retention, where the normal undercut is insufficient. Retarded cement is used to fix the splint in place. This allows approximately 10 minutes working time for applying the splint. Then the splint is applied. The fragments of bone are gradually reduced by insertion of the splint, and then the wings are closed and locked. The interproximal retention screw is inserted. Excess cement is removed completing the insertion of the splint. With the appliance in place, some sidewise motion of the mandible is possible. Intermaxillary rubber bands laced over the hooks on the maxillary arch bar are placed during passive fixation. Rubber bands permit limited relaxation of the liquid feeding during convalescent stages. Controlled fixation may be obtained if desired with steel wire. X-ray after reduction of the fracture shows the splint and maxillary arch in place with the lower border now on the same level as the frontal portion. The graft procedure to be followed in this case is demonstrated on a moulage. A pre-shaped piece of bone will be grafted to the fractured ends to join them together. The bone ends are prepared for the graft and wires are passed through holes drilled in the bone ends to match corresponding holes in the graft. O-14 tantalum wires are used to seat and hold the bone graft. For the actual graft procedure, endotracheal anesthesia is used. Nitrous oxide and oxygen with carare for relaxation. First, the stellate scar is removed. Removal of the scar and dissection of the underlying tissue exposes the bone ends. To establish the size and contour of the graft, a pattern is prepared. Rangeurs are used to freshen up the ends of the mandible and provide a better surface for the attachment of the graft. The end surfaces of bone are evened off to provide maximum contact and good blood supply. The piece of bone for grafting is taken from the crest of the ilium, for it is well-suited for the purpose. The maxillary bone graft procedure is usually performed by a maxillofacial team whose members prepare the field and remove the segment from the hip. The operating time can be materially shortened if a second team exposes and closes the hip. After the piece from the crest of the ilium has been removed, it is trimmed carefully to match the pattern. Then the piece from the hip bone is tried for size in the jaw. It is important to remove all cortical bone fragments adjacent to the graft as these may hinder the blood supply. During the graft procedure, blood is drained off with an aspirator. Holes are drilled in the bone ends of the jaw and the graft to admit the wire used to fasten the bone graft in place. After the bone is pierced, .014 tantalum wire is drawn through from the lingual side. To anchor the bone graft, the wires are, of course, drawn through the holes in the graft. The ends of wire are twisted securely and the excess snipped off. Then the remaining twists are turned in close to the bone to prevent irritation. The wound is closed layer by layer in the usual manner. Finally, a pressure dressing is carefully applied to prevent hematoma, reduce swelling, and avoid displacement. Penicillin is generally administered before and after bone graft procedure as a precaution against infection. After the throat pack has been removed, intermaxillary fixation is affected with elastics or fine wires, twisted to hold the upper and lower teeth together as long as controlled fixation is desired. Use of the cast wing type screw lock sectional splint with the maxillary arch makes it possible to immobilize the jaw until the graft is firmly consolidated. Normal function can then be restored.