FINDINGS:
This is a ***-year-old *** who presented to the emergency room approximately one week prior to admission with history of single blunt trauma to the lower third of the face. The patient underwent CT evaluation in which an angle of the mandible fracture compounded through impacted tooth #32 was made. The patient refused admission and self discharged. The patient returned to the outpatient clinic and was evaluated. Case was discussed. Indications for open reduction, internal fixation versus closed reduction with intermaxillary fixation was reviewed. The patient wishes to defer any type of intermaxillary fixation and consents to open reduction with internal fixation and possible extraction of wisdom tooth. All 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 and maintained via nasotracheal intubation. The patient was prepped and draped in the standard fashion for a transoral surgical procedure.
The oropharynx was thoroughly suctioned, and posterior throat pack was placed. Approximately 5 mL of 1% Xylocaine with epinephrine was infiltrated into the proposed incision site of the right posterior mandible.
With the use of a needle-tip Bovie, a standard 3rd molar incision was made with a #15 Bard-Parkewr blade and extended anterior and posteriorly with the use of a needle tip Bovie. Soft tissues were elevated easily identifying the fracture and partially impacted tooth #32. Good exposure of the external oblique ridge and lateral cortical plate was gained.
The bony segments were manipulated to allow for removal of tooth #32 which was completed with the use of hand instrumentation. Once the extraction was completed and the socket was curetted of soft tissue, the patient was placed into intermaxillary fixation with the use of #19 gauge interproximal wire positioned at the first molar and premolars, bilaterally. Appropriate closed reduction with intermaxillary fixation was gained.
The fracture was fixated with a 4-hole mini-plate along the posterior superior aspect of the mandible bridging the fracture line. Four monocortical screws were fixated into the plate, good reapproximation of the fracture segments were noted. Intermaxillary fixation was removed. The patient demonstrated a stable reduction with an appropriate range of motion and stable reproducible dental occlusion.
The surgical site was thoroughly irrigated with normal saline, and primary closure was gained with the use of 3-0 chromic suture. Oropharynx was thoroughly suctioned, and posterior throat pack was removed. This concluded the surgical portion of the case. The patient was extubated
in the operating room, taken to the recovery room in stable condition.
