PMC6112306_01
Photograph taken at the accident site following large trick tyre blast (A). Intraoperative photograph demonstrating the extensive soft tissue laceration and comminution of the mandible (B).
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One could visualize entire right side of the patients face involving the hard and soft tissue totally avulsed and hanging (Fig. 1A and B).
CT scan pictures depicting the mandibular fractures (A and B), Maxillary fracture (C) and the zygomatic one fracture (D).
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CT (computed tomography) scan done that revealed no neurological abnormality. CT revealed multiple comminuted fracture of the mandible involving right side and parasymphysis fracture of the left side mandible, dentoalveolar fracture involving the maxillary anterior and right maxillary posterior teeth region (Fig. 2A-D).
Intraoperative views showing approximation of the soft tissue (A), fixation of the mandibular fracture (B), maxillary interosseous wiring (C) and final closure (D).
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After carefully releasing the soft tissues entrapped within the bone fragments, inferior alveolar nerve was found to be intact (Fig. 3A). Interdental wiring was done between 44-45 and 32-33 regions to secure the fractured segments (Fig. 3B). The fractured fragments were aligned and plated using 2 mm miniplates (5-hole 4 screws, two 3-hole 3screws and 4-hole 4 screws) respectively (Fig. 3C). Fractured maxillary segments on the right side were approximated using interosseous wiring as plating was not possible owing to the severe comminution of the fractured segments (Fig. 3D).
Postoperative radiographs demonstrate the fixation plates for the multiple mandibular and maxillary fractures along with interosseous wiring (A and B).
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The surgery took around 6 h to complete and postoperative radiographs demonstrated satisfactory approximation (Fig. 4A and B).
Pus discharge developed as a complication (A) and loosening of the intraoral polygalactin suture (B). At discharge, occlusion was satisfactory (C) as well as the healing was satisfactory (D).
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Pus Discharge was evident on the 10th postoperative day over the sutured wound near the angle of mandible (Fig. 5A). Intra orally, sutured Polyglactin material became loose without exposing the fracture site even after thorough and regular irrigation using povidone iodine solution and mouth wash (Fig. 5B). Post operative healing after 1 month revealed satisfactory healing without wound dehiscence and adequate occlusion (Fig. 5C and D).