Abstract
Objective: to report a surgical case of comminuted mandible fracture caused by a firearm projectile treated with external fixation. Methodology: male patient, 18 years old, attended the Emergency Department of the Maxillofacial Surgery service after trauma in the mandibular region by a firearm projectile. On clinical examination, edema was observed in the cervical zone II and mandibular region, penetrating orifice of entry of the projectile in the genial region and mobility in the mandibular body. CT scan revealed a comminuted fracture in the mandible. Transcutaneous perforations were performed with pins, anatomical reduction of the fracture and stabilization to the external nail, adapting to the mandibular anatomy. Following postoperative follow-up, the patient progresses without pain complaints, with functional and satisfactory mouth opening, without mobility in bone fragments, and reestablished mandibular framework. Results and Conclusion: mandibular fractures by firearms are frequent in the routine of the buccomaxillofacial surgeon. Cases of bone comminution present individual peculiarities that must be taken into account in their management. The correct indication of external fixation proved to be adequate and satisfactory for cases of mandible comminution.
Highlights
In the last years the management of mandibular fractures due to firearm injury has undergone significant changes
Objective: to report a surgical case of comminuted mandible fracture caused by a firearm projectile treated with external fixation
The objective of this paper is to present a clinic case of comminuted fracture in the mandibular body region caused by a firearm injury, treated with an orthopedic device of external fixation, as well as to discuss about indications, limitations, management and clinic experiences showing that, when correctly conduced, the use of these fixators is a viable alternative in the surgical treatment of traumas caused by firearm injuries in the mandibular region
Summary
In the last years the management of mandibular fractures due to firearm injury has undergone significant changes. The accepted idea for treating these fractures included the maxim that surgical exploration would lead to loss of blood supply of bone fragments, what would cause a bigger incidence of bone sequestration, necrosis and outbreaks of infection, but this theory was modified (Smith & Teenier, 1996). Another modified factor refers to the idea of “sterile injury”, it is known that the heat generated by the propellant discharge and friction between the bullet and the cylinder are not sufficient to sterilize the projectile, what justifies those being contaminated injuries (Abreu et al 2009)
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