FINDINGS:
This is a ***-year-old *** who approximately 3 days prior to admission suffered single blunt trauma to the lower third of the face. The patient presented to the emergency room in which a diagnosis of mandibular fracture was made. The patient was triaged to the oral surgery service for
definitive surgical care. The case was discussed with the patient immediately preop. Risks, benefits, and alternative therapies were reviewed. Clinical indication for open reduction versus closed reduction were reviewed with the patient. The patient wishes to defer any type of prolonged intermaxillary fixation and therefore, open reduction, internal fixation was the appropriate treatment. The patient is aware that the left V3 paresthesia present from the time of the injury may not resolve. After surgery monitoring in the postoperative period for resolution of sensory nerve function. Questions were answered. The patient is being taken to the operating room in a non-urgent basis.

PROCEDURE:
The patient was taken to the OR and placed on the OR table in the supine position. The patient was induced under general anesthesia maintained via nasotracheal intubation. The patient was prepped and draped in the standard fashion for open reduction, internal fixation of the left mandibular fracture. Posterior throat pack was placed.

Clinical examination noted minimal mobility of the segments and the patient had a very minor open bite deformity on the left hand side. Approximately 10 mL of 1% Xylocaine with epinephrine was infiltrated into the left hemimandible. With the use of a #15 Bard-Parker blade, a  sulcular incision was made from tooth #19 to tooth #22. Anterior vertical release was made into the mucobuccal fold of the midline of the mandible. Soft tissue dissection proceeded in the subperiosteal plane. Upon elevation of the soft tissue flap, purulent exudate was noted within the buccal tissues. Culture and sensitivity was taken at this time. Area were thoroughly irrigated and isolation of the mandibular fracture and isolation of the mental nerve was completed.

A 24-gauge bridle wire over the teeth #21 and #22 was placed. The jaw were maintained in the manual closed reduction with maximal intercuspidation. A mini-plate was placed over the mental foramen spanning the fracture along the buccal cortex. Monocortical screw fixation was placed in a standard manner without complication. A 14 mm positional screw was placed below the level of the mental foramina extending from the buccal cortical plate to the lingual plate of the left mandible bridging the fracture line. Stable fixation and good stability of the fracture  was noted. The bridle wire was removed, and the gingival tissues were thoroughly irrigated and reapproximated with the use of 3-0 chromic suture.

Oropharynx was thoroughly suctioned, the posterior throat pack was removed, and this concluded the surgical portion of the case. The patient was extubated in the operating room and taken to the recovery room in stable condition.