Vityadewi Nurardhilah, Prawoto Almas Nur, Seswandhana M Rosadi, Wahdini Siti Isya, Ramli Rianto Noviady, Dachlan Ishandono
Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito General Hospital, Yogyakarta, 55281, Indonesia.
Ann Med Surg (Lond). 2022 Aug 5;80:104319. doi: 10.1016/j.amsu.2022.104319. eCollection 2022 Aug.
We report a case of an extended comminuted mandibular fracture using a reconstruction plate, miniplates and arch bar. Cases of extended comminuted mandibular fractures report high rates of complications. In this case, the patient subsequently suffered from an infected cutaneous fistule and non-union of the comminuted segments.
An 18-year old male arrived at the emergency room after a motorcycle accident with extensive comminuted mandibular fractures extending bilaterally with splitting at the mandibular angle and shattered bony fragments of the alveolus and mandible body. ORIF was performed using a locking reconstruction plate, miniplates and screw followed by maxillomandibular fixation using the arch-bar. Two weeks after the operation, a cutaneous fistule formed in the submental region. After multiple local debridements with little improvement, surgical debridement was done and a small comminuted bone fragment that underwent nonunion was removed. Final evaluation of the patient showed optimal results with satisfactory masticatory function and an acceptable anatomical shape of the lower jaw.
Extensively comminuted mandibular fractures are known to be difficult to manage. Although the controversy between open versus closed reduction of comminuted mandibular fractures remain, advancements in surgical techniques and equipment has shifted towards open reduction and internal fixation, allowing for better and faster anatomical and functional restoration.
ORIF should be the treatment of choice in extended comminuted mandibular fractures. A mandibular reconstruction plate can be used to achieve a good results with a relatively faster return of function. Although the incidence of infection in mandibular fractures is high, adequate debridement and plate removal can bring good results as seen in this case. Shifting from closed to open reduction allows the patient to have faster results with less complications in the future.
我们报告一例使用重建钢板、微型钢板和牙弓夹板治疗的下颌骨广泛粉碎性骨折病例。下颌骨广泛粉碎性骨折病例的并发症发生率较高。在本病例中，患者随后出现了感染性皮肤瘘管以及粉碎性骨折段不愈合。
一名18岁男性在摩托车事故后抵达急诊室，下颌骨出现广泛粉碎性骨折，双侧骨折延伸至下颌角处裂开，牙槽骨和下颌骨体有碎骨片。采用锁定重建钢板、微型钢板和螺钉进行切开复位内固定（ORIF），随后使用牙弓夹板进行颌间固定。术后两周，颏下区域形成了一个皮肤瘘管。经过多次局部清创但改善甚微后，进行了手术清创并移除了一块出现不愈合的小粉碎性骨碎片。对患者的最终评估显示结果理想，咀嚼功能令人满意，下颌骨的解剖形态可接受。
众所周知，广泛粉碎性下颌骨骨折难以处理。尽管对于粉碎性下颌骨骨折采用切开复位还是闭合复位仍存在争议，但手术技术和设备的进步已倾向于切开复位内固定，从而能够更好、更快地实现解剖和功能恢复。
切开复位内固定应是下颌骨广泛粉碎性骨折的首选治疗方法。使用下颌骨重建钢板可取得良好效果，功能恢复相对较快。尽管下颌骨骨折的感染发生率较高，但如本病例所示，充分清创和取出钢板可带来良好效果。从闭合复位转向切开复位可使患者未来恢复更快且并发症更少。
