Mandibular Symphysis Fractures Research Articles

Finite Element Analysis of New Modified Three-dimensional Strut Miniplate versus Conventional Plating in Mandibular Symphysis and Angle Fractures - An In vitro Study

Abstract Introduction: Mandibular fractures are common injuries during maxillofacial trauma, and currently, open reduction and internal fixation are considered gold-standard treatments. There is a wide discussion about which plates give the best outcomes. Hence, we are conducting a biomechanical comparison of two plates for mandibular symphysis and angle fracture with finite element analysis (FEA). The aim of this study was to do a comparative study of FEA between the conventional and our new modified three-dimensional (3D) strut miniplate in mandibular fractures at symphysis and angle regions. Materials and Methods: Finite element models of symphyseal and angle fractures of the mandible were developed. Each fracture model was then realigned and fixed by the conventional method 2.0 mm system, and our modified 3D strut plating method 2.0 mm system followed by the analysis of various stresses developed in plates and mandibular fracture area after application of load was observed in the study. Results: The modified 3D strut plating system with 2.0 mm miniplates is significantly better in preventing displacement of fracture segments by better distribution of forces compared to the conventional plating system. Rest of the parameters were within the permitted limits. Discussion: Modified 3D strut plating method was reasonably effective and superior in managing force-displacement compared to the conventional method of fixation for comminuted and unfavourable mandibular symphyseal fracture and angle fracture.

Evaluation of Biodegradable Fixation Application for Jaw Fracture in Pediatric Patients

Background: The treatment of jaw fractures in pediatric patients need a special concern and different management than adult patients due to their dynamic and structural changes following their growth patterns. Treatment by open reduction and internal fixation (ORIF) using titanium or biodegradable plates as osteosynthesis material is indicated for displaced jaw fracture. Biodegradable fixation could be used as an alternative choice, using plates and screw that will decompose along with bone healing. Case: Two pediatric patients brought to RSUP Dr. Sardjito, Yogyakarta with complaints of jawbone fracture. The first patient was a 7-years-old woman diagnosed with mandibular symphysis fracture and a left mandibular kondilus fracture, while the second patient was a 15-years-old woman diagnosed with malunion of left maxillary fracture. Fracture treatment was performed using biodegradable fixation. The first patient was repositioned according to the anatomical state and the second patient the maxillary refracture was done before repositioning. Patients were evaluated clinically for up to three months postoperatively and radiological imaging was performed. Evaluation results show good jaw bone union, no malocclusion, no tooth mobility and no paresthesia in both patients. Intraoral wound dehiscence with exposed plate was found in the second patient at the vestibule of the left uper canine until premolar region and can be resolved by removal of the plates under local anesthesiaConclusions:. Biodegradable as an ideal osteosynthesis material for jaw fracture in pediatric patients

Treatment of mandibular symphysis fractures in a pregnant domestic cat

A pregnant domestic cat was found in an accident and taken to the Cikole Animal Hospital at Bandung. Physical examination showed that the cat's body temperature was 35.6℃ and bleeding was found in the eyes, nose, and mouth. Palpation of the dexter and sinister mandibular bones showed loose bones, and palpation of the abdomen showed that the fetus was still moving. Radiographic examination of the head showed that in the dorsoventral position, the mandibular bones were visible at the right and left mandibular symphysis separated by a radiolucent border. The cat was diagnosed with fracture of the mandibular bone symphysis. Therapy is performed by orthopedic surgery through the installation of a wire or surgical wire to connect the two dexter and sinister mandibular bones. After surgery, cats are administered antibiotics, anti-inflammatories, and multivitamins, with special consideration for pregnancy conditions. The dexter and sinister mandibular bones were fixed on the 8th day after surgery.

Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures.

The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.

Can Fracture Reduction be Attempted Through a 3D-Printed Guide Template Without Maxillomandibular Fixation?

Computer-aided design and manufacturing is widely used in clinical practice. This technology may change existing methods for mandibular fracture management. The purpose of this in-vitro study was to determine if the reduction for mandibular symphysis fracture is performed without maxillomandibular fixation (MMF) using 3-dimensional (3D)-printed template. This was an in-vitro study and had the character of a proof-of-concept study. The study was planned using the existing 20 pairs of intraoral scan and computed tomography data. The mandibular model STL file was created by merging the STL file obtained for the bimaxillary dentitions with the computed tomography DICOM file, and this was set as the original model. In the original model, STL file of fracture model of mandibular symphysis was created using computer-aided design. A template similar to a wafer or an implant guide was manufactured from restoring the own occlusion, and the mandibular fracture model was reduced and fixed using the 3D-printed template and wire, and this was set as the experimental group. The 3D coordinate system error was measured at 6 landmarks and statistically compared using scan data between models of the groups. Reduction techniques with MMF or without MMF using guide template for mandibular fracture model. The 3D coordinate system error (mm). The position of landmarks. The Mann-Whitney U test, student's t-test, and the Kruskal-Wallis test were used to analyze the coordinate errors between the landmarks. A P value of < .05 was considered statistically significant. The 3D error value of the control and experimental group were 1.06±0.63mm (range: 0.11 to 2.92mm) and 0.96±0.48mm (range: 0.2 to 2.95mm), respectively. There was no statistical difference between the control and experimental group. There was a statistically significant difference in the lower 2 and lower 3 landmarks compared to the upper 1 (P=.001 and .000, respectively) before and after the reduction in the experimental group. This study demonstrates that the reduction using a 3D-printed guide template for the mandibular symphysis fracture could be possible even without the MMF.

Biomechanical evaluation of two internal fixation systems for the treatment of mandibular symphyseal fracture

Due to the disadvantage of maxillomandibular fixation, the semi-rigid and rigid internal fixations have been employed to provide early mouth motion. To find the proper fixation and adequate stability, the biomechanical performance of these systems was assessed using Finite Element (FE) method. The 3D mandible model with a symphyseal fracture, teeth, periodontal ligament, and fixation devices were created for the FE analyzes. The bone structure was determined as a transverse isotropic whereas the fixation devices were titanium. The load includes Masseter, Medial Pterygoid, and Temporalis muscular forces as well as the occlusal forces acting on first molars, canines, and incisors. The maximum stress occurs at the center of fixation devices at symphyseal fracture. The maximum stress values were 877.4 MPa for the reconstruction plate and 646.8 MPa for the mini-plates. The plates maintained the fracture width at mid-region better than superior and inferior. The maximum fracture gap were 1.10 and 0.78 mm for reconstruction plate and mini-plates, respectively. The fracture site's elastic strain stabilized with the reconstruction plate was 1089.0 microstrains and with the mini-plates was 399.6 microstrains. The treatment of a mandibular symphyseal fracture using a mini-plates provides more adequate fracture stability for new bone formation and mechanically safer than locking reconstruction plate. Mini-plates fixation was able to control the fracture gap better than the reconstruction plate. Mini-plates technique was considered as the first choice of internal fixation, however, a reconstruction plate can also be used in case of unavailability and complication related to mini-plating.

Mandibular symphyseal fracture in dogs: a retrospective study on the incidence and age of cases admitted to the referral teaching hospital of faculty of veterinary medicine, Cairo University, and some private clinics

The mandible and maxilla have unique structural and functional characteristics compared to the rest of the skeleton, which affect the incidence of their fractures, as well as the complications that occur as a result, which may affect other vital systems such as the central nervous, the digestive, and the respiratory systems. Mandibular symphysial fracture in dogs and cats frequently happens as a result of forced trauma like being hit by vehicles, falling down from a height,or fighting. The current study was designed as a retrospective study to record the incidence of dogs’ mandibular symphysial fractures at the hospital of the faculty of veterinary medicine, Cairo University, and some private clinics in Egypt during a three-year study period from Jan 2020 to Dec 2022. This study was conducted on a total admitted fracture case of 949 dogs including 94 skull fractures and 855 other fracture cases with an age ranging from 2 months to 14 years of both sexes. Establishing of skull fractures diagnosis was based on history, clinical signs, and further diagnostic orthopedic examination and x-ray. From the obtained data, it could be concluded that the incidence of dogs’ mandibular symphysial fractures at the hospital of the faculty of veterinary medicine, Cairo University, and some private clinics in Egypt was 5.1% of total canine fracture cases, and 51.1% of total canine skull fractures. Concerning age, mandibular symphysial fractures percentage were 60.4%, 27.1%, and 12.5% out of total mandibular symphysial fracture cases, 30.8%, 13.8%, and 6.4% out of total skull fracture cases, 7.1%, 3.5% and 3.5% out of total fracture cases related age, 3.1%, 1.4% and 0.6% out of total fracture cases, and 59.2%, 46.2% and 40.0% out of skull fracture cases related age of age less than one year, between one to three years and more than three years respectively.

Protocol for management of pregnant patients requiring emergency minor oral surgical procedures: a prospective study in 52 patients.

Dental or maxillofacial emergencies are uncommon during pregnancy, but if they occur, they are challenging to treat due to potential risks. The mother should not be denied necessary medical or dental care because of pregnancy. The aim of the study is to observe outcomes of pregnancy in patients requiring emergency minor oral surgical procedures during gestation and to determine the safety of the pregnant woman undergoing the procedure and the fetus. The study was conducted on 52 pregnant women requiring emergency oral surgical procedures. A standard treatment protocol for treatment of specific entities was followed. Close monitoring and observation were the primary goal of treatment. All patients were followed postoperatively until complete recovery from the surgical procedures and then until birth of the baby. A control group of 52 healthy pregnant patients who did not require oral surgical procedures was considered for statistical analysis. The measurements to calculate observation were fetal loss (spontaneous abortion), preterm birth, low-birth weight, or incidence of any congenital anomalies in the baby and its association with surgical procedures. No fetal loss occurred in any of the cases. However, four patients experienced preterm birth and seven neonates exhibited low birth weights. No congenital abnormalities were discovered. In one instance, a patient who underwent surgery for a mandibular symphysis fracture under general anesthesia in the 31st week of pregnancy experienced labor pain on the fourth postoperative day, requiring an emergency Caesarean section. The results of our study demonstrate that, compared to the control group, minor emergency surgeries performed during pregnancy have no discernible negative effects on the fetus. These procedures can safely be performed by adhering to our described protocols.

Management of a pediatric mandibular symphysis fracture with a custom acrylic cap splint

ABSTRACT Traumatic dentoalveolar injuries in pediatric patients are a common occurrence. Treatment strategies for managing mandibular fractures in pediatric patients are dissimilar to that of adult patients. The dynamic nature of bone, developing tooth buds, parent’s levels of apprehension, and the patient’s level of cooperation are some of the factors which dictate the treatment of choice. Treatment rendered should aim at the stabilization of fractured segments with minimum invasiveness. The purpose of this case report is to describe the management of mandibular symphysis fracture in a 1-year-old boy using an acrylic splint which is stabilized with circummandibular wiring.

Interpositional arthroplasty with temporal muscle flap – a surgical alternative for condylar ankylosis of the temporomandibular joint

Ankylosis of the temporomandibular joint (TMJ) is characterized by a bony or fibrous fusion between the articular fossa and the condyle. It represents one of the greatest therapeutic challenges in oral and maxillofacial surgery. Several treatments have been used for its management, such as gap arthroplasty, interpositional arthroplasty, and TMJ reconstruction with autogenous bone graft and alloplastic prostheses. A 39-year-old Black male patient developed a complex mandibular symphysis fracture associated with bilateral high condylar fractures after a motorcycle accident. In the first approach, osteosynthesis was performed to reduce and fix symphysis fractures and conservatively treat the condyles. However, the patient did not proceed with physiotherapy and adequate follow-up, evolving into bilateral ankylosis. Subsequently, he underwent interpositional arthroplasty with a temporal muscle flap. The treatment of ankylosis is imperatively surgical and aims to release the joint and reanatomize the region, restoring functionality to the stomatognathic system. The choice of technique depends on many factors, including age. In children, gap arthroplasty is the most frequent choice because it helps in the centrality of condylar growth. In adult patients, gap arthroplasty with interposition of the temporal muscle is eligible, as it restores function and reduces the recurrence of bone fusion and consequent re-ankylosis.

Surgical correction of mandibular symphyseal fracture and traumatic umbilical hernia in a cat

Surgical correction of mandibular symphyseal fracture and traumatic umbilical hernia in a cat

Pattern of isolated mandibular symphysis fracture and trends in management at a tertiary care hospital of Karachi, Pakistan.

Objective: To find the pattern of isolated mandibular symphysis fracture and trends in management at a tertiary care hospital of Karachi, Pakistan. Study Design: Crossectional study. Setting: Department of Oral Surgery, Sir Syed Medical &amp; Dental Hospital-Karachi, Pakistan. Period: January 2018 to December 2019. Material &amp; Methods: Eighty one patients were selected on the basis of inclusion and exclusion criteria. They were diagnosed with isolated anterior mandibular fracture on basis of detailed history, thorough clinical examination and a radiologic investigation (OPG). Etiology of fracture and gender distribution was observed, fracture pattern was observed on basis of helmet wearing. Results: There was a male predilection with a male to female ratio of 4.3:1. Road traffic accident was the commonest cause. 82.7 % of patients were not wearing helmet at time of incidence and 69% from all patients had displaced mandibular fracture which resulted in derranged occlusion. Conclusion: Isolated anterior mandibular fractures is common in younger age group, with a male predilection. Most common etiologic factor is road traffic accident. Displaced fracture pattern is prevalent among patients who were not wearing helmet at time of incidence.

Correction of Traumatic Transverse Mandibular Widening With Interdental Wiring.

Mandibular symphysis fractures pose several technical challenges for the craniomaxillofacial surgeon. One classic challenge is restoration of the transverse dimension when the mandible is widened secondary to splaying of the lingual cortex. Failure to diagnose or correct this problem can result in widening of the lower facial third, inadequate fracture reduction, and/or a malocclusion. Surgeons have traditionally utilized techniques such as manual pressure to the rami or lingual splint application to address transverse defects intraoperatively. However, these methods may be inadequate in situations with significant widening, such as in the case of concomitant subcondylar fractures. More recently, virtual surgical planning and custom hardware have been utilized to address mandibular widening, though this method also has various shortcomings. In this technical note, the authors present a simple technique using interdental wiring to precisely control mandibular width intraoperatively. The technique is cost effective, does not require an assistant, and can be used in conjunction with any of the above methods. The authors also present a case of secondary reconstruction in which use of this technique was necessary given a large degree of mandibular widening not amenable to reduction and fixation with manual pressure alone.

Is Perpendicular Double Two-Hole Plates Fixation Superior to Single Four-Hole Plate Fixation to Treat Mandibular Symphysis Fracture?—A Finite Element Study

The effectiveness of a single four-hole plate (S4HP), perpendicularly oriented four-hole and two-hole plate (Per4H2HP), and perpendicularly oriented double two-hole plate (PerD2HP) for the fixation of a mandibular fracture was studied. A finite element analysis of the mandibular symphysis fractures treated with S4HP, Per4H2HP, and PerD2HP was performed. All surface nodes were fixed in the mandibular condyle region and occlusal muscle forces were applied. The maximal von Mises stress (MaxVMS) values of the plates, screws and screw holes were investigated. The displacement of the fracture site on the lower border of the mandibular symphysis was recorded. The displacement on the lower border of the fracture sites in the S4HP group was greater than that in the Per4H2HP group and the PerD2HP group. There was no eversion at the fracture site among all groups. Both the S4HP and Per4H2HP groups showed stress concentrations on the screws close to the fracture site. The MaxVMS increased when the number of screw holes on the mandibular anterior lower border decreased. The displacement of the fracture site and eversion with Per4H2HP and PerD2HP were far lower than those with S4HP. PerD2HP is a stable and green fixation technique for mandibular symphysis fractures.

Finite Element Analysis of Two- and Three-Dimensional Fixation in Treating Mandibular Symphyseal Fracture Combined With Bilateral Condylar Intracapsular Fractures.

The aim of this study was to compare through finite element analysis two- and three-dimensional (2D and 3D) fixation in the treatment of mandibular symphyseal fracture combined with bilateral condylar intracapsular fractures. The authors created 2 fixation models for the above fracture, and analyzed the stress and displacement in the mandible and fixation materials under 3 loading conditions. The von Mises stress of the mandible and plates peaked during lateral occlusion, and was lowest during central occlusion. In all conditions, stresses in the fixation materials did not exceed the yield stress of titanium. The inferior border of the symphyseal fracture segments showed opposing displacements, and the mandible tended to widen in the 2D fixation model. However, the fracture displacement did not exceed 150 μm for either fixation method. The results suggested that after well reduction and fixation of condylar intracapsular fractures, either 2D or 3D fixation for symphyseal fracture can provide adequately strong fixation. Compared with 2D fixation, 3D fixation has more advantages in controlling the mandibular width and preventing the fixation materials from enduring excessive stress.

Surgical Reduction of Symphysis Fracture and Spontaneous Repositioning of the Mandibular Condyle: A Case Report

The condylar process is a more fragile area, which is usually fractured by indirect trauma. The objective of this study is to report the case of a 10-year-old patient who presented to the Maxillofacial Surgery and Traumatology Service of the Regional Hospital of Vale do Paraíba, in Taubaté-SP, Brazil. Physical examination revealed limited mandibular movement with painful symptoms, crossbite, and upper incisor avulsion. A face tomography showed a fracture of the mandibular symphysis (right side) and a fracture of the left condyle. Surgical reduction of the mandibular symphysis fracture was performed. After exposure and reduction of bone segments, maxillomandibular block, rigid internal fixation and conservative treatment for condyle fracture were performed. A soft liquid diet and weekly outpatient follow-up was adopted for the first two months. After 15 days of surgery, the patient had mild edema, slight limitation in mouth opening, sutures without dehiscence and without signs of infection. In the first control tomography, the treated fracture was adequately reduced and the fractured condyle remained with medial displacement in the glenoid cavity. After one year, on physical examination, the patient presented satisfactory dental occlusion, preserved mandibular movements and no signs of nerve damage. The tomography showed the fracture consolidated, and the left mandibular condyle well positioned in the glenoid cavity. After two years, the third tomography was performed, showing remodelling of the left mandibular condyle.

Comparison of the mechanical properties of biodegradable and titanium osteosynthesis systems used in oral and maxillofacial surgery

To guide the selection of osteosynthesis systems, this study compared the mechanical properties of biodegradable and titanium osteosynthesis systems. SonicPins Rx and xG were subjected to pull-out tests. Additionally, 15 biodegradable (Inion CPS 2.0 and 2.5 mm; LactoSorb 2.0 mm; Macropore 2.0 mm; Polymax 2.0 mm; BioSorb FX 2.0 mm; ResorbX 2.1 mm; Osteotrans-MX 2.0 mm with plate thicknesses 1.0 and 1.4 mm; SonicWeld Rxplate/Rxpins, xGplate/Rxpins and xGplate/xGpins 2.1 mm without and with tapping the burr hole) and six titanium (CrossDrive (2006), CrossDrive (2018), MaxDrive; all 1.5 and 2.0 mm) straight, four-hole osteosynthesis systems were evaluated. All systems were subjected to tensile, bending and torsion tests. Pull-out loads of the SonicPins were comparable (P = 0.423). Titanium systems’ tensile loads were higher than biodegradable systems (P < 0.001). CrossDrive (2018) and MaxDrive systems’ tensile and torsional stiffness were lower, accompanied with higher ductility, than corresponding CrossDrive (2006) systems (P < 0.001). Bending stiffness of 1.5 mm titanium systems was comparable to, and of the 2.0 mm systems higher than, all biodegradable systems (P < 0.001). Regarding biodegradable systems, Inion CPS 2.5 mm had highest tensile load and torsional stiffness, SonicWeld 2.1 mm highest tensile stiffness, and BioSorbFX 2.0 mm highest bending stiffness (P < 0.001). On the basis of the results of this study, the CrossDrive (2018) and MaxDrive 1.5 mm titanium systems are recommended for midface fractures (e.g., zygomatic or maxillary fractures) and osteotomies (e.g., Le Fort I osteotomy), and the CrossDrive (2018) and MaxDrive 2.0 mm titanium systems for mandibular fractures and osteotomies when a titanium osteosynthesis system is used. When there is an indication for a biodegradable osteosynthesis system, the SonicWeld 2.1 mm or BioSorbFX 2.0 mm are recommended for midface fractures and osteotomies, and the Inion CPS 2.5 mm biodegradable system for mandibular osteotomies and non-load bearing mandibular fractures, especially when high torsional forces are expected (e.g., mandibular symphysis fractures).

Open reduction and internal fixation of mandibular left parasymphyseal fracture and conservative management of bilateral condylar fracture in a pillion rider- “Rules should be followed not ignored’

Maxillofacial injuries sustained through Road traffic accidents (RTAs) is one of the leading causes of hospitalization in India. Numerous factors such as ever increasing amount of two wheelers, assault conditions, lack of safety measures such as helmets, seat belts and lack of strict implementation of such rules, prevailing socioeconomic, cultural and environmental factors results in a substantial number of facial fractures from RTAs. By 2020, RTA injuries will rise as the 6th major cause of death worldwide. One of the most commonly employed means to thwart such RTAs include the use of helmet, following speed limits, obeying stop signs and traffic signals. Among two wheelers, the use of Helmets plays a crucial role in protecting the cranial vault and potentially the facial skeleton if a full face helmet is used. 25% of the RTAs are caused due to two wheelers rather than four wheelers. Pillion rider, who ride passenger behind the rider on a two wheelers more suspectible to morbid injuries due to lack of safety measures like not wearing a helmet, improper sitting patterns especially by females in India. A study showed injuries such as contusion and skull fractures are common when riding pillion. Here we report a case of mandibular symphysis fracture along with bilateral subcondylar fracture with medial displacement of the fractured segment sustained via RTA while riding pillion.

Internal Fixation of a Complicated Mandibular Fracture in a Filly Using a String-of-Pearls Locking Plate Assisted by a 3D Printed Model

Abstract Objective The aim of this study was to describe the successful surgical treatment of a complicated mandibular fracture with a 3.5 mm string-of-pearls (SOP) locking plate in a 5-month-old Appaloosa filly presenting with neurological signs. Study Design This is a case report. Results The neurological signs were due to severe head trauma and stabilized with medical treatment. Financial concerns initially prevented advanced imaging; radiographs identified a mandibular symphysis fracture, a fracture of the left vertical ramus that originated at the junction between the horizontal and vertical ramus and extended toward the coronoid process and rostral maxillary fractures. Following intra-dental wiring of the symphysis fracture, a lateral malocclusion developed. Computed tomography additionally identified fractures of the right wing of the basisphenoid bone, right zygomatic arch, left paracondylar process and the lateral body of the mandible. The vertical ramus fracture was repaired utilizing a 20-hole 3.5 mm SOP plate contoured to the ventral aspect of the angle of the mandible. A scaled (1:4) three-dimensional printed model aided pre- and intra-operative surgical planning. The filly was comfortable and eating well at the 4-week recheck. Radiographs showed good callus formation at the maxilla, healing of the mandibular symphysis and ramus. Just prior to the 10-week recheck, the filly suffered severe enterocolitis and was euthanatized. Conclusion The locking function of the SOP plate provided adequate stability for the fracture to heal without the expense of locking screws. The three-dimensional printed model aided in navigation of the complex fracture without the availability of fluoroscopy.

Transoral Approach to Open Reduction of a Traumatic Avulsion Fracture of the Genial Tubercle Associated With a Mandibular Symphysis Fracture: A Case Report and Literature Review

Genial tubercle fracture (GTF) is rare and represents a diagnostic challenge as plain film radiography often fails to identify the fractured segment. Traumatic avulsion of the genial tubercle in conjunction with mandibular symphysis fracture may lead to posterior displacement of the tongue with the potential for airway compromise and difficulty in speech and swallowing due to loss of tongue anterior suspension. Fine cut computed tomography (CT) scan is required to confirm the diagnosis and assist further management. To our knowledge, all published cases of surgical intervention in the management of avulsed genial tubercle combined with fracture of the mandibular symphysis used an extraoral approach via submental skin incision to expose the fractured segment. To the authors’ knowledge, this is the first report to describe a transoral approach in the surgical management of GTF associated with a mandibular fracture.