Vol 21 No. 1

J Bagh College Dentistry Vol. 21(1), 2009 Closed reduction for...
MATERIALS & METHODS
Patients' age & gender
The study discuss and prospectively review
the results of 32 dentulous patients derived from
population of patients with missile injuries
admitted at the oral & maxillofacial surgery
department at Al-Yarmouk Teaching Hospital in
the period between october 2006 – october
2007.The extremes of patient age ranged from
21-58 years.
Diagnosis
Diagnosis of mandibular fractures based on
clinical and radiographic examination. Clinical
examination of the face included extra and
intraoral examination. The local examination was
done to diagnose or exclude the presence of
mandibular fractures. Extraoral examination
achieved by inspection for the presence of
swelling, ecchymosis, bleeding, soft tissue
laceration, changes in facial contour, limitation
or any abnormal mandibular movements.
Bimanual palpation of the mandible with both
hands to detect any step deformity, tenderness or
crepitation on pressure. Compression test was
used by the application of gentle compression of
the mandible using both hands in two opposite
directions under the lower border to elicit pain
which indicate mandibular fracture.
Intraoral examination was started by
inspection for the presence of sublingual
hematoma, mucosal lacerations and changes in
occlusion. Teeth were examined for quantity,
quality and occlusal relationship, gentle
manipulation for mobility of fractured segments
and displacement.
Radiographic examination include the
essential radiographs and according to their
availability (plain radiographs as
posteroanterior view of the mandible, oblique
lateral view, intraoral occlusal view), Panoramic
view OPG as shown in (Figure 3 and 4),
computed tomography CT scans (axial and
coronal).
Maxillomandibular fixation MMF
Closed reduction and indirect skeletal
fixation the sole method of treatment, with jaws
fixed using arch bars (Erich pattern) as a mean
of intramaxillary fixation for the maxilla and
mandible (Figure 2), MMF was carried out with
soft stainless steel wires (0. 35 mm gauge or 0.4
mm) for all patients. Circumferential wiring
used in two cases only for support and elevation
of badly displaced mandibular fractures.
Immobilization for 6 weeks being the general
guideline. Reduction and fixation of
comminuted mandibular fractures achieved in
25 cases under local anesthesia and in 7 cases
under general anesthesia. All patients were
placed on antibiotic treatment (prophylactic or
therapeutic for already present infection) with
possible use of culture and sensitivity test if
possible from the time of admission until five
days postoperatively. Osseous union of the
fracture was tested clinically after 6 weeks of
MMF, tie wires replaced if union is not
satisfactory. To follow patients and monitoring
for late complications, patients seen every 2
weeks after immobilization for the first 2
months then every month for at least 6 months.
RESULTS
In this study 26 of the injured patients were
males 81.8% (table 1). Patients with age group
20-29 years are mainly sujected to missile
injuries as shown in table 2. Mandibular body
was the commonest site for comminuted
fractures 50% (table 3). Transient and permanent
complications showed high rate 53.1% and less
than half of patients 40.6% required further
reconstructive surgery as shown in tables 5 and
6. There was statistically significance at
probability level < 0.05.
Table 1: Gender distribution.
Gender Number %
Male 26 81.8
Female 6 18.8
Table 2: Age distribution.
Age group Number %
10-19 year 2 6.2
20-29 18 56.2
30-39 8 25
40-49 4 12.5
Table 3: Number of patients and fracture
site.
Number of
Site of fracture %
patients
body region
angle
symphysisparasymphysis
Ramus
16
7
6
3
50
21.8
18.7
9.3
Table 4: imaging studies.
Imaging study number %
Posteroanterior
True lateral
OPG
Oblique lateral
Occipitomental
Occlusal
CT scan
32
32
20
5
4
2
3
100
100
62.5
15.6
12.5
6.2
9.3
Oral and Maxillofacial Surgery and Periodontology 93