The Role of External Fixation in Complex Mandibular Fractures-Case Report

Abstract

The disastrous open comminuted mandibular fractures were difficult in management. Although rigid internal fixation became a standard modality for treatment of facial bone fractures, it might not be satisfied for complex mandibular fractures associated with contamination or tissue loss. In the past, we had 481 cases of mandibular fractures. There were two cases of this series treated with modified external fixation which were mandibular fractures with infection, bony defect, soft tissue avulsion and unstable general condition. The advantages of external fixation were:(1) prevention of striping the fractures site and denuding the remaining blood supply from the small, partially devitalized segments, which tallied with the basic consideration in management of facial fracture;(2) offering the strong support, adequate dental occlusion and immediate mobilization of the temporo-mandibular joint without intermaxillary fixation (IMF);(3) easily applying with less operative time, removing as an outpatient procedure without general anesthesia and being able to adjust the alignment in the postoperative period. On the other hand, external fixation might act as a temporary procedure when there was a bony defect. After resolving concomitant problems, ex. infection, the bone grafts were applied and fixed with internal fixator. The other disadvantages included inconvenience of outer pine care, extra weighted loading, psychological or mental effect caused by the appearance. The obvious pin-tract scar was another straitened problem especially in young female patients. However, external fixation provided an alternative choice in some special conditions.