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Abstract: The mandible is located in the lower third of the face and is prominently positioned, making it vulnerable to injury from blows. In this case, the patient had facial trauma from a car accident, and clinical examination was performed after consultation. A large amount of blood was seen in the oral cavity, a misaligned bite, abnormal bone movement and bone rubbing sounds in the mandible, and a step sensation on palpation of the bleeding site. Three-dimensional CT examination of the head was performed, suggesting multiple fractures of the mandible. After admission, he was treated with internal fixation of jaw fracture by incision and repositioning, after which the occlusal relationship was well restored and the fracture healed well.
Basic information】Female, 35 years old
Type of disease】Multiple fractures of the mandible
Hospital】The First Hospital of Harbin Medical University
Date of consultation】June 2018
Treatment plan]: Maxillary fracture incision and internal fixation
Treatment period】10 days of inpatient treatment and 3 months of outpatient follow-up
Results】Good recovery of occlusal relationship and good fracture healing after surgery
I. Initial Consultation
The patient came to the emergency department of our hospital after being injured in a car accident. After consultation with the corresponding departments, other traumatic injuries were discharged and the patient was seen in the oral surgery clinic. The patient had old blood on the face, mild swelling in the lower jaw, restricted opening, and blood clots in the mouth. Then, an occlusal relationship examination was performed, which showed that the anterior teeth were reversed (dentition) and open (dentition), and only some of the posterior teeth could be occluded; shaking the teeth, some of the teeth moved together with the jawbone below; the bone mass between the median mandible and the right mandibular angle area moved abnormally, and bone rubbing sounds could be heard during movement. No step sensation was palpable due to facial swelling. After placing sterile gauze to compress the bleeding area in the oral cavity to stop bleeding, a 3D CT examination of the jaws was performed immediately. 3D CT returned: multiple fractures of the mandible, and immediate hospitalization was recommended.
II. Treatment history
Immediately after admission, anti-inflammatory and rehydration treatment was administered, and the patient was advised to apply local cold compresses to help stop the hemorrhage. Examination of the oral cavity revealed mucosal lacerations, and debridement sutures were immediately performed under local anesthesia. 2 days after debridement, local hot compresses were recommended to help reduce swelling; one week later, facial swelling subsided, and surgery was recommended. The patient and family were introduced to the surgical options in general. Surgical options: 1. incisional internal fixation: try to choose an intraoral incision for repositioning and strong internal fixation, which is characterized by, exact repositioning and fixation, good fracture alignment, fast and good fracture line healing, but high cost, many incisions and large trauma; 2. incisional internal fixation + intermaxillary traction repositioning in the mandibular angle area. It is characterized by exact repositioning and fixation of the mandibular angle area and good recovery of the occlusal relationship, but the fracture line alignment may not be as good as option 1, with lower cost, fewer incisions and less trauma. The fracture recovery may be slower than option 1, and after communication, the family chose the surgical approach of option 1.
III. Treatment results
Soon after the operation, he could eat normally, and the postoperative occlusal function recovered quickly. During the hospital stay, he checked the patient and family members daily and advised them to strengthen nutrition to promote fracture healing; because there were a lot of bacteria in the mouth, which could easily cause infection, so he brushed his teeth carefully after eating and before going to bed to prevent incision infection. About 10 days after the operation, the mandibular continuity recovered well and the occlusal relationship recovered well. After observing the satisfactory recovery of the occlusal relationship, the patient was discharged home for recovery. After a follow-up visit 3 months after discharge, the patient’s mandibular continuity was completely restored and the occlusal relationship was well recovered.
IV. Notes
We are glad that the patient had a successful surgery and was discharged successfully, but after the patient was discharged from the hospital, he should enhance nutrition to promote fracture healing. For diet, soft food and high protein food are recommended. Calcium tablets and vitamin D3 can be supplemented as prescribed by the doctor to promote the deposition of calcium salts into the jawbone and facilitate fracture healing. Brush your teeth carefully after each meal and before going to bed to prevent infection inside the mouth as well as the incision. Review the surface tomogram 3 months after surgery to observe the fracture healing and remove the stitches on time. If local discomfort occurs during the recuperation period, early follow-up is recommended.
V. Personal insight
Mandibular fractures are often caused by trauma, and patients will show obvious fracture characteristics, including limited mobility, local swelling, abnormal bone movement at the fracture site, and bone rubbing sound during movement, etc. Patients should promptly seek medical consultation to clarify the fracture site by 3D CT of the jaws. After the indications for surgery are met, the treatment plan should be selected taking into account the location of the fracture line, whether it is displaced, the patient’s economic situation and the advantages and disadvantages of each plan, and the treatment plan should be determined after timely communication with the patient and family. After surgery, patients should be advised to take good personal care, including local hygiene, anti-infection, and nutritional supplements.