J Korean Assoc Oral Maxillofac Surg.  2014 Jun;40(3):135-139.

Treatment of extensive comminuted mandibular fracture between both mandibular angles with bilateral condylar fractures using a reconstruction plate: a case report

• Lee K
• Yoon K
• Park KS
• Cheong J
• Shin J
• Bae J
• Ko I
• Park H

Abstract

This following case report describes the open reduction, internal fixation and the reconstruction of an extensive comminuted mandibular fracture with bilateral condylar fractures in a 19-year-old male patient with an intellectual disability and autistic disorder. He suffered fall trauma, resulting in shattered bony fragments of the alveolus and mandibular body between both mandibular rami, the fracture of both condyles and the avulsion or dislocation of every posterior tooth of the mandible. The patient underwent open reduction and internal fixation between both mandibular rami using a reconstruction plate, open reduction and internal fixation of the shattered fragments using miniplates and screws, and the closed reduction of the bilateral condylar fractures.

Keyword

Fractures; Comminuted; Mandibular fractures; Fracture fixation

MeSH Terms

Autistic Disorder
Dislocations
Fracture Fixation
Humans
Intellectual Disability
Male
Mandible
Mandibular Fractures*
Tooth
Young Adult

Figure

• 

  Fig. 1 Preoperative images of computed tomography axial view and three-dimensional reconstruction view. There are scattered fragments of mandible andposterior teeth.

• 

  Fig. 2 Intraoperative photo showing a reconstruction plate, miniplates and screws used for internal fixationand steel wires used for maxillomandibular fixation.

• 

  Fig. 3 At postoperative 6 week follow-up, 23 mm of mouth opening was measured.

• 

  Fig. 4 Extraroal photograph of the 6-weeks after the surgery showing favorable healing of soft tissue.

• 

  Fig. 5 Posterior-anterior view image of the 10-weeks after operation. Signs of non-union were not found.

Reference

1. Finn RA. Treatment of comminuted mandibular fractures by closed reduction. J Oral Maxillofac Surg. 1996; 54:320–327. PMID: 8600240.

2. Chrcanovic BR. Open versus closed reduction: comminuted mandibular fractures. Oral Maxillofac Surg. 2013; 17:95–104. PMID: 22842858.

3. Li Z, Li ZB. Clinical characteristics and treatment of multiple site comminuted mandible fractures. J Craniomaxillofac Surg. 2011; 39:296–299. PMID: 20605726.

4. Alpert B, Tiwana PS, Kushner GM. Management of comminuted fractures of the mandible. Oral Maxillofac Surg Clin North Am. 2009; 21:185–192. PMID: 19348983.

5. Smith BR, Teenier TJ. Treatment of comminuted mandibular fractures by open reduction and rigid internal fixation. J Oral Maxillofac Surg. 1996; 54:328–331. PMID: 8600241.

6. Kazanjian VH. An outline of the treatment of extensive comminuted fractures of the mandible: based chiefly on experience gained during the last war. Am J Orthod Oral Surg. 1942; 28:B265–B274.

7. Ellis E 3rd. Treatment of mandibular angle fractures using the AO reconstruction plate. J Oral Maxillofac Surg. 1993; 51:250–254. PMID: 8445465.

8. Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg. 2006; 34:421–432. PMID: 17055280.

9. MacLennan WD. Fractures of the mandibular condylar process. Br J Oral Surg. 1969; 7:31–39. PMID: 5258903.

10. Marker P, Nielsen A, Bastian HL. Fractures of the mandibular condyle. Part 1: patterns of distribution of types and causes of fractures in 348 patients. Br J Oral Maxillofac Surg. 2000; 38:417–421. PMID: 11010766.

11. Lindahl L. Condylar fractures of the mandible. I. Classification and relation to age, occlusion, and concomitant injuries of teeth and teeth-supporting structures, and fractures of the mandibular body. Int J Oral Surg. 1977; 6:12–21. PMID: 402318.

12. Choi KY, Yang JD, Chung HY, Cho BC. Current concepts in the mandibular condyle fracture management part II: open reduction versus closed reduction. Arch Plast Surg. 2012; 39:301–308. PMID: 22872831.

13. Dahlström L, Kahnberg KE, Lindahl L. 15 years follow-up on condylar fractures. Int J Oral Maxillofac Surg. 1989; 18:18–23. PMID: 2497204.

14. Ellis E, Throckmorton GS. Treatment of mandibular condylar process fractures: biological considerations. J Oral Maxillofac Surg. 2005; 63:115–134. PMID: 15635566.

15. Beekler DM, Walker RV. Condyle fractures. J Oral Surg. 1969; 27:563–564. PMID: 4978291.

16. Pereira CC, LetíciaDos Santos P, Jardim EC, Júnior IR, Shinohara EH, Araujo MM. The use of 2.4-mm locking plate system in treating comminuted mandibular fracture by firearm. Craniomaxillofac Trauma Reconstr. 2012; 5:91–96. PMID: 23730424.

17. Collins CP, Pirinjian-Leonard G, Tolas A, Alcalde R. A prospective randomized clinical trial comparing 2.0-mm locking plates to 2.0-mm standard plates in treatment of mandible fractures. J Oral Maxillofac Surg. 2004; 62:1392–1395. PMID: 15510361.