J Korean Assoc Oral Maxillofac Surg.  2018 Dec;44(6):275-281. 10.5125/jkaoms.2018.44.6.275.

A working paradigm for managing mandibular fractures under regional anesthesia

• Chellappa
• Meshram V
• Kende P
• Landge J
• Aggarwal N
• Tiwari M

• KMID: 2467174
• DOI: http://doi.org/10.5125/jkaoms.2018.44.6.275

Abstract

OBJECTIVES
Isolated mandibular fractures contribute to approximately 45% of maxillofacial traumas. Improper management of mandibular fractures can cause myriad potential complications and can lead to serious functional and aesthetic sequelae. The objective of the study is to design a stepwise approach for managing isolated mandibular fractures using open reduction and internal fixation (ORIF) with regional anesthesia on outpatient basis.
MATERIALS AND METHODS
Patients with isolated mandibular fractures presenting to the department of maxillofacial surgery were selected for ORIF under regional anesthesia based on occlusion, age, socioeconomic status, general condition, habits, and allied medical ailments. Standard preoperative, intraoperative, and postoperative protocols were followed. All patients were followed up for a minimum of 4 weeks up to a maximum of 1 year.
RESULTS
Of 23 patients who received regional anesthesia, all but one had good postoperative functional occlusion. One patient was hypersensitive and had difficulty tolerating the procedure. Two patients developed an extraoral draining sinus, one of whom was managed with local curettage, while the other required hardware removal. One patient, who was a chronic alcoholic, returned 1 week after treatment with deranged fracture segments after he fell while intoxicated.
CONCLUSION
With proper case selection following a stepwise protocol, the majority of mandibular fractures requiring ORIF can be managed with regional anesthesia and yield minimal to no complications.

Keyword

Mandibular fractures; Regional anesthesia; Complications; Perioperative management; Champy's lines

MeSH Terms

Alcoholics
Anesthesia, Conduction*
Curettage
Humans
Mandibular Fractures*
Outpatients
Social Class
Surgery, Oral

Figure

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  Fig. 1 Extraoral approach for management of right parasymphysis fracture combined with right condylar and right coronoid fracture under regional anesthesia. A. Preoperative orthopantomograph showing fracture. B. Deranged occlusion. C. Extraoral exposure through laceration. D. Wound closure. E. Postoperative occlusion after 6 weeks.

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  Fig. 2 Displaced right parasymphysis fracture managed through extraoral approach under regional anesthesia with lag screw and 4-hole titanium miniplate. A. Deranged occlusion. B. Fracture site exposed through extraoral laceration and fixation done. C. Preoperative mandibular occlusal view. D. Postoperative mandibular occlusal view. E. Postoperative occlusion.

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  Fig. 3 Comminuted right body and angle fracture managed under regional anesthesia. A. Right lateral oblique mandible. B. Orthopantomograph (OPG). C. Intraoral exposure and fixation of fracture segments. D. Postoperative OPG. E. Postoperative occlusion after 6 weeks.

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