Patient: Description of condition (onset time, main symptoms, hospital visited, etc.): Change of mandibular impeachment fracture after fixation and left mandibular neck bone fracture and dislocation after car accident, misalignment of bite. After 21 days of upper and lower arch splinting and elastic traction fixation, the bite is still misaligned after removal of the collar, and now continue to do traction, from external surgery both may lead to facial expression stiffness or inability to open the mouth, what kind of treatment can not affect the facial nerve and other functions and can restore the function of the bite? Wang Zhaoling, Department of Stomatology, General Hospital of Jinan Military Region
Patient: CT photo of May 25 review
Wang Zhaoling, Department of Stomatology, General Hospital of Jinan Military Region.
In your case, it is best to do an incision and internal fixation of the fracture of the condylar neck, which is the most ideal for functional recovery.
However, the anatomical repositioning of this surgery is relatively difficult, try to choose a level unit to avoid taking down the fracture segment and then implanting it back, so that the surgical complications will be much less and the functional recovery will be much better.
Patient: I had a car accident on May 4 at around 16:00 p.m. I had a plate fixation surgery on May 13, traction on May 19, and a review of the collar on May 25. Is this an external surgery you are referring to? Is there a risk that the external surgery or the internal oral surgery, which is less risky, will affect the facial stiffness or will be worse than before the surgery? Where can this surgery be done? What is the approximate cost? Thank you
Wang Zhaoling, Department of Stomatology, General Hospital of Jinan Military Region.
The incision is made in front of the ear screen, which is very concealed and not too obvious.
After the surgery, the ear is fixed with a titanium plate, and the effect is much better than traction.
There are many places that can do this surgery, and the cost varies from place to place. You should ask the doctor if they can do this surgery, mainly whether the fracture end above should be removed and put back, then the effect will be much worse.
All surgeries have risks, so don’t worry too much, a skilled surgeon will keep it to a minimum.
Patient: Dr. Wang, besides the question of whether the fracture end should be taken out and put back in, do you need to pay attention to any other problems? Which hospital is better for this kind of surgery? Is Shanghai Ninth People’s Hospital or West China Dental Hospital good for this kind of surgery? Do they have enough experience to do this kind of surgery? The Ninth Hospital of Shanghai and West China Dental Hospital are the only hospitals I know of, can you recommend them?
Jinan Military General Hospital, Department of Stomatology Wang Zhaoling: These two are fine, the surgery is not very complicated, experienced specialists are fine, do not worry too much.
Patient: Dr. Wang, please ask, I started traction on May 19 until now. I’ve had one traction since May 19, and I’m still having a slight misalignment, but I’m still having a second traction. Is the longer the traction, the better? If the collar is still misaligned on June 24, does it have to be operated? It’s been a month and a half since the accident, so is surgery more difficult and less effective? My doctor in Guizhou said the chance of complications from surgery is 30%. Is the chance that high no matter where you do it?
Wang Zhaoling, Department of Stomatology, General Hospital of Jinan Military Region.
As mentioned above, surgical treatment is best in your case! Traction has been January the effect is not satisfactory further delayed surgery will also increase the difficulty.
The bite is misaligned or not depends on your own feelings, if the bite is good you can choose to continue traction.
Do not overthink the problem of complications, the problems you have now should be more serious than the complications of surgery.
Wang Zhaoling, Department of Stomatology, General Hospital of Jinan Military Region.
As mentioned above, surgical treatment is best in your case! Traction has been January the effect is not satisfactory further delayed surgery will also increase the difficulty.
The bite is misaligned or not depends on your own feelings, if the bite is good you can choose to continue traction.
Don’t overthink the complications, the problems you have now should be more serious than the surgical complications.