Complications of Mandibular Fracture Repair and Secondary Reconstruction

Abstract

Mandibular fractures are common facial injuries. Their treatment varies as do postoperative complications. This paper discusses the common complications that are associated with the treatment of mandibular fractures and presents management strategies.

Keywords: complications; fractures; mandible.

Fig. 1

Records of a patient who was treated elsewhere for left angle and symphysis fractures of the mandible. He complained that his bite was off and that his face looked asymmetric. Additionally, he said he had no feeling in the left lower lip and chin. ( A ) Facial photograph showing more fullness on the left side of his face. ( B ) Photo of his occlusion showing left crossbite. ( C ) Panoramic radiograph showing bone plates attached to the mandible in the symphysis and angle regions. Note the three lower screws through the bone plate at the angle are directly over the inferior alveolar canal. ( D ) Posteroanterior radiograph showing lateral displacement of the mandibular ramus. ( E ) Frontal and ( F ) left lateral photos of the patient's dental models mounted on an articulator. ( G ) The lower cast was segmented through the symphysis and the pretrauma occlusion was re-established ( H,I ). Intraoperative photographs of the symphysis ( J ) after an osteotomy was performed through the original fracture site and the left angle ( K ) after a sagittal ramus osteotomy was performed through the ramus, fragment mobilization, reestablishment of mandibulomaxillary fixation, and bone plate osteosynthesis. ( L ) Postoperative panoramic radiograph showing completed osteotomies. ( M ) Frontal photograph of the patient after healing. ( N ) Occlusal photograph after healing and arch-bar removal.

Fig. 2

Records of a patient who underwent extraction of a lower left third molar and subsequently developed a fracture through the mandibular angle. The patient was placed into mandibulomaxillary fixation (MMF) for several weeks, but the fracture never consolidated. The patient had slight mobility and pain when occluding. ( A ) Photograph of slight malocclusion caused by the fracture. ( B ) Panoramic radiograph showing fracture through the left angle. Note patient is in MMF using Ivy loops. ( C ) The fracture was exposed through a transfacial approach. Note the fibrous tissue within the fracture gap. ( D ) The fracture after removal of the fibrous tissue and mobilization. ( E ) Temporary fixation after the patient was placed into MMF and the condylar fragment seated into the glenoid fossa. ( F ) Intraoperative check of the occlusion by taking out of MMF and assuring that the mandibular dentition rotates into the proper relationship with the maxillary dentation. ( G ) Final load-bearing fixation applied across the fracture site. ( H ) Temporary fixation plate is removed and particular bone marrow graft is inserted into the fracture site. ( I ) Final occlusal relationship after healing. ( J ) Final panoramic radiograph demonstrating osseous healing.

Fig. 3

( A ) panoramic radiograph of a patient with a left angle fracture. It was treated with a single miniplate. ( B ) Facial photograph 6 weeks after surgery showing redness and swelling of the left angle region. ( C ) Panoramic radiograph showing unstable fixation and clockwise rotation of the mandibular ramus on the left side. ( D ) Computed tomography scan showing large abscess formation around the left angle of the mandible. The patient was taken to surgery and the left miniplate was removed. The left lower molar was also removed ( E ) because it was infected, and an incision and drainage was performed through a transfacial approach ( F ). A reconstruction bone plate was applied at the same time ( G ) and a drain was placed. ( H ) Panoramic radiograph at 12 weeks showing complete healing.

Fig. 4

Radiographs of a patient whose mandibular fracture was stabilized with mandibulomaxillary fixation screws. ( A ) Immediately after surgery. ( B ) After removal of the MMF screws. Note the hole through the root of the lower left first premolar.

Fig. 5

Postoperative panoramic radiograph of a patient who was treated with bone plate fixation for a left angle and right body fracture. Both were treated through a transoral approach. Note that the posterior portion of the reconstruction bone plate applied to the right mandibular body is too high, with all screws entering the inferior alveolar canal. This can occur because visibility and access in the posterior mandible is very limited when using a transoral approach.

Fig. 6

Intraoperative photograph of a patient treated through a transoral approach for a right mandibular body fracture. Note that the mental nerve has been avulsed.