Fracture Mandible Repair: A Challenging Oral & Maxillofacial Surgery

Dr Nazrul Islam

A patient of 35 years came to United Hospital with history of Road Traffic Accident and with complaints of inability to close his mouth. Clinical evaluation suggested a possible fracture in the lower jaw; CT scan confirmed initial clinical diagnosis revealing a mandibular midline fracture. Treatment plan was done for open reduction of the mandibular fracture followed by bone plating and intra arch immobilisation. Under GA, fracture site was exposed and reduction was done manually. Fixation was done with two site plating, one at the upper dento alveolar bone and other at the lower border of the mandible. Titanium bone plate and screws were used for fixation. Upper and lower arch bar were used for intra arch immobilisation and occlusion was corrected with wire traction. Follow up traction was applied with elastic traction for 4 weeks. Three month post-operative follow up showed normal occlusion and bite with normal jaw relation. This was a case of mandible midline fracture with deranged occlusion. In such case, bilateral muscle pull in the masticatory area makes the situation unfavorable for fracture reduction as the muscle action tends to open the fracture line in the middle. That’s why two level immobilisation with bone plating is necessary in such cases to prevent fracture reduction failure. Further manual maneuvering of the fracture parts to correct the bite, though difficult, was done by wire pulling with arch bar.