PMC10402857_01
CT craniomaxillofacial findings revealed a complex, tripartite mandibular fracture, including bilateral condylar fractures with lateral dislocation of the left condyle and a symphyseal fracture. Specifically, there was a comminuted left condylar fracture with medial and inferior displacement of the fracture fragments as well as lateral and inferior dislocation of the intact lateral aspect of the condyle; near complete right subcondylar fracture with lateral apex angulation as well as medial and inferior dislocation of the right mandibular condyle; a mildly distracted oblique left parasymphyseal fracture; retrognathism; and, associated perimandibular soft tissue edema with mild subcutaneous edema on the right, and a 1.0 cm hematoma adjacent to the left mandibular condyle.
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Computed tomographic (CT) craniomaxillofacial findings revealed a tripartite mandibular fracture, including bilateral condylar fractures with lateral dislocation of the left condyle and a symphyseal fracture (Figure 1).
Clinical photograph intra-operatively showing the 2.8 mm threaded Steinman pin placed from left mandibular angle to right mandibular angle with a red rubber catheter with a xeroform dressing placed over the external portion of the pin for protection.
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This Steinman pin was cut, and a red rubber catheter with a xeroform dressing was placed over the external portion of the pin for protection (Figure 2).
The immediate post-operative CT maxillofacial scan revealed anatomic reduction of the fracture Sites.
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TMJ and the mandibular angles with persistent medial dislocation of the right condyle (Figure 3).
On physical examination at this 2-month follow up time, the patient was noted to have facial symmetry, class I occlusion, full oral excursion, and very minimal scarring at the left transfacial pin placement site.
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On physical examination at this 2-month follow up time, the patient was noted to have facial symmetry, class I occlusion, full oral excursion, and very minimal scarring at the left transfacial pin placement site (Figure 4).
The follow-up CT maxillofacial scan at 5-months post-initial surgery demonstrated relocation, remodeling, and bony healing. Specifically, the left TMJ is restored and relocated, the right condylar fracture has remodeled and is in nearly anatomic pre-injury location, and the symphyseal fracture has healed.
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A follow-up computed tomography scan taken 5 months after the initial surgery demonstrated stable reduction of the left TMJ, remodeling of the right condylar fracture to near anatomic position, and radiographic healing of the symphyseal fracture (Figure 5).
The patient's clinical photographs at 5-month follow up showing facial symmetry, class I occlusion (pre-injury normal occlusion), full oral excursion, and nearly imperceptible scarring at the left transfacial pin placement site.
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Physical exam demonstrated facial symmetry, class I occlusion with no retrognathia, full oral excursion with no deviation of the lower jaw, full facial nerve function and a small scar at the left transfacial pin placement site (Figure 6).