MANDIBULAR FRACTURE AFTER WIRE SUSPENSION REDUCTION TECHNIQUE IN PATIENT WITH HIV

Abstract

We are pleased to present this unusual case concerning a patient with bimandibular fracture secondary to fixation with circum-mandibular wires. A 29-year-old HIV-positive male patient presented with right angle mandibular traumatic fracture without displacement. He was partially dentate, so conservative treatment was performed. We applied a simple but underused method which uses intermaxillary fixation in combination with piriform aperture and circum-mandibular wires.1 Stable fixation and mandibular immobilization, as well as proper reduction and satisfactory dental occlusion, were achieved. We checked this patient two weeks after the surgical treatment, and he showed a proper evolution. But he did not come to the second and third reviews, and his whereabouts were unknown. Six months later, he came to us presenting with bilateral fracture of both mandibular bodies, directly related to the two circum-mandibular wire fixations (Fig. 1). Then, we proceeded to remove the wired material and placing four miniplates on the fractures of the mandibular bodies, following the dictates of the AO/ASIF. The treatment of mandibular fractures in HIV patients is controversial. The surgeon tries to use the easiest and safest method. Smith et al.,2 in a study of 251 patients treated for mandibular fractures, found that the overall rate of postoperative infection was significantly higher in HIV-positive than in HIV-negative patients. They also reported that the use of open reduction and internal fixation in HIV patients represented a significant risk of postoperative infection. But, on the other hand, Martinez-Gimeno et al.,3 in a study of 171 patients with mandibular fractures, concluded that miniplates were a good osteosynthesis medium in HIV patients and intermaxillary fixation seems to increase the infection rate in the HIV-positive group. We share the opinion that patients with HIV should be treated with osteosynthesis miniplates because: