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Jaw Fracture Surgery - Comminuted Fracture of the ramus of Mandible internal fixation

10/3/2019

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This young man was riding his bike to work when the signal turned red. He braked suddenly, which caused the car that was tailgating him to rear end his bike. This sudden impact caused him to lose his balance and fall directly on his chin. Of note, he was not wearing a helmet at the time of the accident. There were some minor bruises and lacerations, but what caused him great alarm were the grating noises he heard upon attempting to open his mouth and speak.

Realizing that something was not right, onlookers at the site of the accident informed his parents over his mobile phone and took him to a nearby hospital for treatment. Doctors at the hospital administered first aid with thorough debridement of his lacerations due to the presence of road dirt. He was also administered a tetanus toxoid to avoid the possibility of tetanus.

His parents had reached the hospital by then and they were informed that their son had multiple fractures to his lower jaw. They referred the patient and his parents to Balaji Dental and Craniofacial Hospital as it is renowned for facial fracture surgery in India. Many patients with fractures of the jaws are referred to us because we are a specialty jaw fracture surgery hospital.

Dr SM Balaji examined the patient and ordered imaging studies upon their arrival at the hospital. This revealed that the patient had a displaced fracture of the body of the mandible on the left along with a nondisplaced ramus fracture on the right. He also had a fractured lower left second premolar tooth.

All the findings were explained to the patient and his parents. It was advised that he emergently undergo open reduction and internal fixation of the two fractures with titanium plates and screws along with extraction of the fractured tooth. They were also informed that his jaws would be wired shut for a period of 2-3 weeks following surgery to allow for the bones to be held stable during the healing period. They were in complete agreement with the treatment plan and signed the written informed consent for surgery.
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The patient was taken to the operating room and placed under general anesthesia. The fracture sites were accessed through intraoral incisions to avoid any visible scars on the patient’s face from the surgery. The fractured tooth was then extracted.

The displaced body of the mandible fracture was addressed first. The fractured segments of the mandible were stabilized and fixed using titanium plates and screws. A similar procedure was then performed on the right ramus fracture. Correct occlusion was ascertained before fixing the fracture with the titanium plates and screws. The patient’s jaws were then wired shut using Intermaxillary fixation.
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The patient was advised to stay on a liquid diet until his jaw wiring was removed and to stay on a soft diet for a further fortnight after that. Surgical results were excellent and the patient and his parents expressed their complete satisfaction at the results of the surgery.
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