Multiple Mandibular Fractures Research Articles

Biomechanical evaluation of various rigid internal fixation modalities for condylar-base-associated multiple mandibular fractures: A finite element analysis.

Condylar-base-associated multiple mandibular fractures are more prevalent than single ones. Direct trauma to mandibular symphysis, body or angle are prone to induce indirect condylar fracture. However, little is known about the effects of various rigid internal fixation modalities in condylar base for relevant multiple mandibular fractures, especially when we are confused in the selection of operative approach. Within the finite element analysis, straight-titanium-plate implanting positions in condylar base contained posterolateral zone (I), anterolateral zone (II), and intermediate zone (III). Von Mises stress (SS) in devices and bone and mandibular displacement (DT) were solved, while maximum values (SSmax and DTmax) were documented. For rigid internal fixation in condylar-base-and-symphysis fractures, I + II modality exhibited least SSmax in screws and cortical bone and least DTmax, I + III modality exhibited least SSmax in plates. For rigid internal fixation in condylar-base-and-contralateral-body fractures, I + III modality exhibited least SSmax in screws and cortical bone, I + II modality exhibited least SSmax in plates and least DTmax. For rigid internal fixation in condylar-base-and-contralateral-angle fractures, I + III modality exhibited least DTmax. The findings suggest that either I + II or I + III modality is a valid guaranty for rigid internal fixation of condylar base fractures concomitant with symphysis, contralateral body or angle fractures.

Advances in open reduction and internal fixation of multiple mandibular fractures with condylar involvement.

Multiple mandibular fractures with condylar involvement are challenging to treat. This paper aims to present a series of steps to simplify the treatment and improve the outcomes in open reduction and internal fixation of multiple mandibular fractures with condylar involvement. The authors reviewed the developments in their practice in treating the above injuries. As a result, four new elements were identified: three-dimensional printing, model surgery, Kirschner wires to manipulate the segments in condylar fractures, and a top-to-bottom sequence. The above algorithm has contributed to streamlining the procedure and improving the outcomes of these challenging fractures. For the same operator, reduction and osteosynthesis require approximately 40 min. less than before the adoption of the new protocol. So far, the authors did not encounter suboptimal reductions or situations where the screws were too long and therefore had to be exchanged for shorter ones in revision 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.

Do Racial and Ethnic Disparities Exist in Management of Pediatric Mandible Fractures? A 30-Year Outcome Analysis.

Mandibular fractures are the most common of pediatric facial fractures. The effect of race on management/outcomes in these injuries has not been previously studied. Given the significant association between race and healthcare outcomes in many other pediatric conditions, an in-depth study of race as related to mandibular fractures in the pediatric patient population is warranted. This was a 30-year retrospective, longitudinal study of pediatric patients who presented to a single institution with mandibular fractures. Patient data were compared between patients of different races and ethnicities. Demographic variables, injury characteristics, and treatment variables were analyzed to find predictors of surgical treatment and posttreatment complications. One hundred ninety-six patients met inclusion criteria, of whom 49.5% were White, 43.9% were Black, 0.0% were Asian, and 6.6% were classified as "other." Black and "other" patients were more likely than their White counterparts to be injured as pedestrians (P = 0.0005). Black patients were also more likely than White patients or "other" patients to be injured by assault than by sports-related injuries or animal-related accidents (P = 0.0004 and P = 0.0018, respectively). Race or ethnicity were not found to be a predictor of receiving surgical treatment (ORIF) or of posttreatment complications. The posttreatment rates for all the complications observed were comparable among all race and ethnic groups. Higher mandible injury severity score (odds ratio [OR], 1.25), condyle fracture (OR, 2.58), and symphysis fracture (OR, 3.20) were positively correlated with receiving ORIF as treatment. Mandible body fracture (OR, 0.36), parasymphyseal fracture (OR, 0.34), bilateral mandible fracture (OR, 0.48), and multiple mandibular fractures (OR, 0.34) were negatively correlated with receiving ORIF as treatment. Only high mandible injury severity score (OR, 1.10) was identified as an independent predictor of posttreatment complications. Lastly, Maryland's transition to an all-payer model in 2014 also had no impact on treatment modality; treatment of fractures among race and ethnicity were not significantly different pre- and post-2014. There is no difference in how patients are treated (surgically vs nonsurgically) and no difference in outcomes for patients based on race at our institution. This could be due to institutional ideology, services provided by a tertiary care center, or simply the more diverse patient population at baseline.

Current Frequency of Mandibular Condylar Process Fractures.

There are significant discrepancies in the reported prevalence of condylar process fractures among all mandibular fractures (16.5-56%) in the available literature. In addition, it seems that the actual number of difficult-to-treat fractures of the mandibular head is unknown. The purpose of this study is to present the current incidence of the different types of mandibular process fractures with a special focus on mandibular head fractures. The medical records of 386 patients with single or multiple mandibular fractures were reviewed. Of the fractures found, 58% were body fractures, 32% were angle fractures, 7% were ramus fractures, 2% were coronoid process fractures, and 45% were condylar process fractures. The most common fracture of the condylar process was a basal fracture (54% of condylar fractures), and the second most common fracture was a fracture of the mandibular head (34% of condylar process fractures). Further, 16% of patients had low-neck fractures, and 16% had high-neck fractures. Of the patients with head fractures, 8% had a type A fracture, 34% had a type B fracture, and 73% had a type C fracture. A total of 89.6% of the patients were surgically treated with ORIF. Mandibular head fractures are not as rare as previously thought. Head fractures occur twice as often in the pediatric population than in adults. A mandibular fracture is most likely related to a mandible head fracture. Such evidence can guide the diagnostic procedure in the future.

Primary Management and Treatment Consideration for Patients with Mandibular Fracture and Cervical Spine Injury: A Case Report

Introduction: Traffic accidents were the main cause of craniofacial trauma. High force trauma to the head and neck regions may involve mandibular fractures and cervical spine injuries. The principles of trauma management (ABCDE) are often modified and supplemented with other methods in case of multiple trauma injuries. Management of the patient during trauma protocols and operative treatment has the potential to cause serious spinal cord injuries. Case: The clinical case is shown from the adult male patient, 22 years old, which came to Hasan Sadikin Hospital emergency department with a wound in the face, bleeding from the mouth, after having a traffic accident. There was no history of alcohol intoxication and loss of consciousness. The patient was diagnosed with multiple mandible fractures and cervical spine injury. Case management: Based on adequate clinical, laboratory, and radiographic examination, emergency management is based on ATLS principles, including treatment consideration for the patient with a cervical spine injury. Conclusion: Multiple mandibular fractures were correlated with a cervical spine injury. A multidisciplinary approach, including consultation with neurosurgeons for diagnosis and stabilization of cervical spine injuries.

What Are Possible Contributors to Associated Dental Injury in Mandibular Fractures?

Among previous reports on dental injuries associated with mandibular fractures, there are few investigating the conditions under which dental injuries commonly occur. The aim of this study was to determine specific characteristics of mandibular fractures accompanied by dental injuries. This retrospective cohort study included dentate patients with mandibular fractures treated at a tertiary trauma center between 2011 and 2019. The data were analyzed according to 2 outcome variables: patients with additional dental injuries and patients without. The predictor variables were patient age, sex, accident mechanism, number and location of mandibular fractures, and presence of submental lacerations. Odds ratios for the risk factors for dental injury were calculated in conjunction with descriptive statistics. Binary logistic regression analysis was also performed to identify the factors associated with dental injuries as dependent variables. Of 252 patients who had only mandibular fractures, 95 (37.7%) had associated dental injuries. In the group with dental injuries, 55.8% of mandibular fractures were caused by a fall (P=.003). Condyle fractures (77.9%) with dislocation (67.6%) and bilateral involvement (41.9%) were more common than in the group without dental injuries (P < .001). In patients with dental injuries, the incidence of 3 or more fractures (29.5%) was significantly higher than in the group without dental injuries. Dental injuries were more likely to occur in patients with concomitant submental lacerations (confidence interval (CI) 1.135-4.983, P=.02), and the risk of dental injury was significantly lower in the presence of angle fractures (CI 0.113-0.999, P=.045). A frontal impact involving the anterior part of the mandible is often associated with condyle and multiple mandibular fractures. This seems to be the typical mechanism for concomitant dental injuries. Submental laceration can be considered a prime sign of associated dental injuries.

Comparison of Preauricular Approach Versus Retromandibular Approach in Management of Condylar Fractures

Objectives: Surgical treatment of patients with multiple mandibular fractures involving condylar segments may be a difficult proposition for a maxillofacial surgeon. These fractures can be double or triple fractures of the lower mandible and can also be associated with other fractures of the face. While many authors have suggested that the conventional approach to reducing and stabilizing a mandibular symphysis / para-symphysis fracture is appropriate before addressing a fractured condyle, there is another school of thought that suggests that the condylar segment should be reduced and repaired first. This article aims to review the results of operations where the reduction and fixation of a fractured condyle is performed prior to other associated mandible fractures, and to explore the effectiveness of various surgical methods including preauricular and retromandibular proposed in this case. Place and Duration: In the Oral and Maxillofacial surgery department of Faryal Dental College, Lahore for two-years duration from Jan 2018 to Jan 2020. Material and methods: The study included 60 surgically treated patients with multiple mandible fractures (double / triple), including the condyle component. For treatment of the fractured condylar segments, the preauricular and retromandibular (anterior parotid-transmasseteric) approach was used. Results: Condyle fracture was the first segment to be managed during sequencing of surgical treatment, regardless of the method used. First, good reduction and stabilization have been achieved with limited complications in treating a condyle fracture. Conclusion: While it is the surgeon's prerogative to sort multiple mandible fractures, addressing the condylar segment first provides the operator with a viable alternative to the conventional technique. Key words: condylar fractures, multiple mandibular fractures, preauricular approach, retromandibular approach

Analysis of Complication in Mandibular Angle Fracture: Champy Technique Versus Rigid Fixation

The mandibular angle endures tension and compression during mastication, and proper internal fixation is essential when a fracture occurs. The authors analyzed the complication rate between Champy technique and rigid fixation, used in the treatment of mandibular angle fracture. The retrospective study included patients with mandibular angle fracture in single center, from January 2003 to December 2019. The patients were categorized into 2 groups by fixation method of angle fracture: Champy technique which uses single miniplate and rigid fixation which uses multiple miniplate, reconstruction plate, compression plate, lag screw, and wire. Pearson chi-square test was used to analyze the complication rates. A total of 64 patients met inclusion criteria. Thirty-four patients had isolated angle fractures and 30 patients had multiple mandibular fractures. In isolated angle fracture, there were no significant differences in all complications between the Champy technique group and rigid fixation group. In multiple mandibular fractures, there were no significant differences in all complications between 2 groups. For isolated angle fractures, Champy technique is a reliable treatment method. Additionally, in case of multiple mandibular fractures, Champy technique is an effective fixation method in angle fractures when proper rigid fixation is performed for accompanying fractures.

Trends in mandibular fracture patterns in central Telangana - A retrospective overview and analysis.

Socio-economic, environmental and cultural influences may lead to discrepancies in the distribution and occurrence of orofacial injuries. The aim of this study was to analyze the patient demographics and current patterns of mandibular fractures within a geographic population. The medical records of patients with facial trauma treated over a period of 3years were retrieved and reviewed. Their data were analyzed based on the following parameters-age, gender, mechanism of trauma, seasonal variation, drug/alcohol abuse at the time of trauma, number, and anatomic location of fractures. Of all the patients with maxillofacial injuries, 56% had mandibular fractures and 80% of these were sustained in road traffic accidents. Nearly 44% of patients had multiple mandibular fractures giving an average of about 1.6 fractures per mandible. Alcohol abuse was seen in 39% of patients. Seasonal influence indicated that the monsoon season had the highest incidence of trauma. Fracture patterns vary according to the etiology of the fracture and direction of the impact force. This information can help in the diagnosis and as a guide to future funding of preventive public health programs.

Comminuted Mandibular Fractures in a Pediatric Patient: A Case Report with Review

Background and Introduction:Maxillofacial fractures are less common in children. Mandibular fractures are less in children because of the protective anatomy in them. Management of the pediatric fracture depends on the type and severity of the fracture displacement. It can vary from conservative management with acrylic splint and arch bar fixation to surgical exposure of the fracture site with internal fixation. Special consideration is needed in children for the interferences of growth and developing tooth buds while going for the surgical management. The hardware for internal fixation can be made up of either titanium or bioresorbable material.Case Presentation:Here is the presentation of a case of a 7-year-old male patient who had a history of trauma because of falling from a tractor while playing, 2 days back from reporting. He had multiple mandibular fractures with extensive soft tissue laceration. Following the emergency tracheostomy, he was managed with open reduction and internal fixation of the compound mandibular fracture.Conclusion:Displaced mandibular fractures require open reduction and internal fixation of the fractured fragments with either titanium or biodegradable hardware. Open reduction also shortens the period of intermaxillary fixation and hence reduces the possibility of the development of temporomandibular joint (TMJ) ankylosis.

Quality of life patients after treatment of mandibular fractures with ORIF in oral surgery departement of Dr. Sardjito general hospital

Management of mandibular fracture using open reduction Internal fixation (ORIF) method is one of the ideal treatments for single and multiple mandibular fractures. The aim of this study was to determine the quality of life of patients after the treatment of mandibular fractures with ORIF using miniplate in single and multiple mandibular fractures. This research used case-control by recalling 43 research subjects in the oral surgery department Dr Sardjito general hospital between 2013 and 2017, that consisted of patients suffering from 23 single fractures and 20 multiple mandibular fractures. Each fracture would be examined clinically and subjectively. Clinical examination parameters were conducted using the mandibular mobility index (MMI) consisting of mouth opening assessment, left and right lateral mandibular excursion, and mandibular protrusive movement. Subjective parameters were performed based on general oral health asseesment index (GOHAI) questionnaire to assess physiological aspects, psychosocial aspects, and pain. The results of the chi-square test statistic study showed that the quality of life of a patient with a single mandibular fracture was better than that of multiple mandibular fractures based on MMI and GOHAI examinations. It was concluded that patients with a single mandibular fracture had a younger age, longer time adaptation and have a better quality of life.

Right mandibular angle and left comminuted mandibular body fractures stabilised with a combination of an acetabular plate and secured pin intermandibular ventral epoxy resin (SPIVER) frame in a four‐month‐old puppy

SUMMARYThis case report aimed to describe a surgical technique combining a secured pin intermandibular ventral epoxy resin (SPIVER) frame and an acetabular plate to manage a complex mandibular fracture configuration in a puppy. A four‐month‐old, entire male, German wirehaired pointer was referred for assessment of a combination of recent (three days before hospitalisation) and older traumatic (45 days before hospitalisation) facial injuries inflicted by the dam. CT revealed multiple mandibular and maxillary fractures with complex acute mandibular fractures requiring surgical stabilisation. wo techniques were combined on stabilisation of the mandible: a single acetabular plate 2.7 to repair the mandibular angle fracture and a SPIVER frame to repair the comminuted mandibular fracture. Both fractures healed uneventfully, and the dog had normal jaw function one year postoperatively. Occlusion was not modified compared with the preoperative condition, considering that the patient already had a malocclusion defect due to old lesions. The combination of two different osteosynthesis techniques had satisfactory short‐term and long‐term outcomes in this puppy.

A significant effect of bone anisotropy on reliability measurements of mini-plate fixation system used in multiple mandibular fractures: A clinical case of angular and parasymphysis fractures

A significant effect of bone anisotropy on reliability measurements of mini-plate fixation system used in multiple mandibular fractures: A clinical case of angular and parasymphysis fractures

The surgical sequencing and techniques in the management of multiple mandibular fractures involving the condyle: A review of 121 surgical cases

Aims: Surgical management of patients presenting with multiple fractures of the mandible involving condylar segments can be a challenging proposition to the maxillofacial surgeon. These fractures can be double or triple mandibular fractures and may also be in association with panfacial fractures. Even though most authors suggest that the conventional approachof reduction and fixation of the mandibular symphysis/ parasymphysis fractures, prior to addressing the fractured condylar segment is appropriate, there exists another school of thought suggesting that the condylar segment must be reduced and fixed first. This article aims to review the outcomes of surgery when reduction and fixation of the fractured condyle is done prior to other associated mandibular fractures and looks into the various surgical approaches advocated for the same. Materials and Methods: 121 surgically treated patients with multiple (double/ triple) mandibular fractures including a condylar component were reviewed. The preauricular, periangular and the retromandibular (anterior parotid-transmasseteric) approaches were advocated to access the fractured condylar segments. Results: The fractured condyle was the first segment to be addressed during the sequencing of the surgical management, irrespective of the approach used. Good reduction and fixation with limited complications were achieved by addressing the condylar fracture first. Conclusion: Sequencing of multiple mandibular fractures, though the prerogative of the operating surgeon, addressing the condylar segment first, provides the operator with a viable alternative to the conventional technique.

Double unilateral, bilateral, and multiple mandibular fractures: an observational study.

Double and multiple mandibular fractures are associated to high morbidity and functional damage. This study aimed to evaluate the characteristics and outcomes of double unilateral, bilateral, and multiple mandibular fractures. A 7-year observational retrospective analysis was performed, and the injury-related data were collected from the medical records. Statistical analysis was performed using Fisher's exact test (p < 0.05). In this period, 283 patients showed mandibular fractures. Of them, 83 (29.7%) had double or multiple mandibular fractures and were included in the study. Double bilateral fractures were more prevalent than multiple or double unilateral. Multiple fractures presented significant association with the combination of load-bearing and load-sharing fixation protocols. Most cases (94.0%) applied at least one type of internal fixation system. However, there was a positive association between condylar fractures and non-surgical treatment (p < 0.01). Moreover, mandibular body fractures were associated with load-bearing fixation (p < 0.01). In 56 cases, no complications were observed (67.5%). Complications were divided into treatment failure (10.8%) and transitory or minor complications (21.7%). There was no statistical association between complications and fracture pattern, fracture-tooth relation, and treatment modality. Double and multiple mandibular fractures represented almost one third of all mandibular fractures, and regardless to treatment protocol, there was no difference about complications. Moreover, although a considerable complication rate was found, most of them were minor or transitory.

Does the frequency of temporomandibular myofascial dysfunction differ in patients treated for different mandibular and zygomatic fractures?

Aim: To determine whether the frequency of Temporomandibular myofascial dysfunction (TMD) differs in patients treated for different mandibular and zygomatic fractures. Materials and Methods: This was a 9-year prospective study. The diagnosis of TMD was based on standard diagnostic criteria and was made during follow-up reviews of patients after the treatment of the fractures. Additional information obtained from the patients and their case files were age, gender, site of fracture (s), and treatment methods. One-way analysis of variance was used to compare the presence of TMD among the study groups. Results: Overall, 42/587 (7.2%) patients were diagnosed with TMD between 2.3 and 4.7 years after treatment commenced. Patients who presented with TMD were those treated for isolated zygomatic (n = 5/42, 11.9%), isolated condylar (n = 7/63, 10.0%), and multiple mandibular (n = 30/475, 6.3%) fractures, which was significant (P = 0.01) in favor of those treated for isolated zygomatic and isolated condylar fractures. Patients who were treated for unilateral zygomatic complex/arch(P == 0.001), unilateral intracapsular condyle (P = 0.001), and parasymphyseal/body/angle/condyle (P = 0.01) fractures also had higher frequencies of TMD. Conclusions: Patients who were treated for isolated zygomatic or condylar fractures had higher frequencies of TMD than those with multiple mandibular fractures. Future research work needs to be directed toward the description of the pathogenesis of the different types of TMD symptoms so that more information can be gathered on the natural course of the disorders and identify the risk factors for pain persistence and chronicity.

Mandibular Fracture Patterns at a Medical Center in Central Taiwan: A 3-Year Epidemiological Review.

Mandibular fractures constitute a major portion of maxillofacial trauma and may lead to considerable functional and aesthetic sequelae if treatment is inadequate or delayed. An epidemiology study on mandibular fractures may guide the preventive efforts of the Taiwan public health care system. Therefore, a retrospective review was conducted at a medical center in central Taiwan to evaluate the current mandibular fracture epidemiology.The medical records and digitized radiographs of 198 patients who received treatment for mandibular fractures during a 3-year period (from October 2010 to September 2013) at a medical center in central Taiwan were reviewed to obtain demographic and injury data.The average age was 29.4 years (3–82 years). Patients aged 21 to 30 years sustained the most mandibular fractures (62 patients, 31.3%). The overall sex distribution (male to female) ratio was 1.8. Motor-vehicle accidents (MVAs) were the most common mechanism of injury (162 patients, 82%), and scooter and motorcycle riders wearing partial-coverage helmets constituted the majority of patients. A chart review identified 198 patients with 335 mandibular fractures; 113 patients (57.1%) had multiple mandibular fractures. The most common fracture sites were the symphysis and parasymphysis regions (38.9%), followed by the condyle (26.0%), angle (14.3%), body (14.3%), and ramus (6.6%).MVAs are the major cause of mandibular fractures in central Taiwan, and patients aged <30 years sustained the most mandibular fractures. Compared with previous studies, the present study has a higher percentage of women with mandibular fractures. In addition, inadequate mandibular protection by partial-coverage helmets may be a major reason for mandibular fractures most commonly localized in the symphysis and parasymphysis regions. The incidence and causes of mandibular fractures may reflect the trauma patterns within the community, thus facilitating the development of a preventive strategy for the socioeconomic and environmental background of central Taiwan.

Gunshot Wounds to the Mandible: A 21-Year Urban Trauma Center’s Experience

1. Abstract <span style=font-size:10.0pt; font-family: times= new= roman,serif=> <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.1. Purpose: Gunshot wounds to the mandible are complex injuries that are difficult to treat and have a high complication rate [1] . This study examined an urban trauma center’s experience in the methods of treatments used and the outcomes of mandibular gunshot wounds. <span style=font-size:10.0pt; font-family: times= new= roman,serif=> <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.2. Methods: A retrospective review of the trauma center registry identified 105 patients with gunshot wounds to the mandible treated between February 1991 and December 2012. Sufficient data was found on 67 patients and descriptive information was collected regarding demographic information, fracture location, and treatment regimen. Outcome data was measured in patients with documented follow-up of 4 weeks or longer. <span style=font-size:10.0pt; font-family: times= new= roman,serif=> <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.3. Results: A total of 67 patients with mandible fractures due to gunshot wounds were identified. The mean patient age was 30.8 years (range, 15 - 71 years), with most patients being male (86.6%). The mandibular angle was the most commonly affected region (43.4%) followed by the mandibular body (36.3%). 40.3% of patients presented with multiple mandibular fractures. Of the 60 patients who underwent surgical management, 22 (36.6%) underwent closed reduction with Maxilla-Mandibular Fixation (MMF), 3 (5%) underwent external fixation only, 2 (3.3%) underwent MMF and external fixation, 12 (20%) underwent Open Reduction and Internal Fixation (ORIF), and 21 (35%) underwent ORIF with MMF or external fixation. Fifty patients had adequate follow-up time ranging from 4 to 530 weeks (median 18 weeks.) From this group, we identified 19 major and 1 minor complication (42%). Minor complications included complications managed in an outpatient setting (infection treated with oral antibiotics, seroma, etc.). Major complications included infected hardware, infection requiring incision and drainage, non-union, malocclusion, and extrusion of hardware. <span style=font-size:10.0pt; font-family: times= new= roman,serif=> <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.4. Conclusions: Mandibular fractures as a result of gunshot wound injury are devastating injuries often characterized by multiple fractures, comminuted fractures, and large areas of missing bone [1,2]. The common presentation of multiple facial fractures and significant anatomic displacement are frequent indications to treat with ORIF [3] . The results of our study show that the complication rate in patients treated with ORIF remains high. The patients included in this study had variable clinical presentations, and we can only conclude that treatments other than ORIF, such as closed reduction with MMF or external pin fixation, must still be considered [1,3-5]. <span style=font-size:10.0pt; font-family: times= new= roman,serif=> 2. Keywords: Fracture; Gunshot wound; Mandible; Maxilla-Mandibular Fixation; Rigid fixation

A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries.

The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case.