A 27-year-old presented to the emergency department after a road traffic accident with marked swelling in the neck and airway obstruction. The patient presented with a comminuted fracture and displacement of mandibular symphysis lingual cortical plate. This was causing an obstruction of the upper airway and required open reduction.
The patient was intubated immediately on arrival, as there had been extensive oral bleeding. For examination, an emergent cerebral angiogram was performed, which showed mental artery extravasation and a transcatheter arterial embolisation was performed. Computed tomography showed open fractures in both the maxilla and mandible.
An open reduction was performed six days later. Intermaxillary fixation and osteosyntehsis of the maxillary fracture was done using arch-bars. In addition, intra-oral buccal sulcus and mental skin incisions were used to expose the comminuted mandibular fracture. Mini-plates were used for mandibular bone reduction and fixation. The fragment of the lingual cortical plates was securely fixed with lag screws.
Post-operative CT showed that the fragment of the lingual cortical plate formed favourable bone alignment and was attached to the menton. After 2 weeks of surgery, the intermaxillary fixation was removed. Similarly, 6 month later, the plates were removed.
Post-operative swallowing function and diet of the patient were satisfactory.
The primary considerations when treating comminuted mandibular fractures are open reduction and internal fixation. Additionally, the outcome of the treatment aims at shortening the period of orofunctional rehabilitation and restoring satisfactory occlusion. However, the patterns of mandibular fractures vary. There are some dislocations that require special attention for preventing post-operative swallowing dysfunction and upper airway obstruction.
References
Split Fracture and Displacement of Mandibular Lingual Cortical Plate of Mandibular Symphysis Requires Fixation https://clinmedjournals.org/articles/tcr/trauma-cases-and-reviews-tcr-1-019.php?jid=tcr
