Combined symphyseal and lower subcondylar mandibular fracture

Abstract

Mandibular fractures have increased their incidence on a worldwide scale. Due to their importance in maxillofacial trauma, the management of a patient with a combined symphyseal and lower subcondylar mandibular fracture is described. This is a 23-year-old male patient who presents with trauma in the mandibular region, reporting pain and mobility in anterior teeth. The physical examination reveals absence of transmitted noises in the region of the left condyle, lateromentonism and displacement of bone fragments at the level of the central incisors. Anteroposterior and town radiographs are performed, corroborating the diagnosis of two combined symphyseal and lower subcondylar mandibular fractures. Emergency surgery is performed, under general nasotracheal anesthesia, the bottom of the vestibular sulcus is incised from 33 to 43, mucoperiosteal flap, bone splinters are removed and fractured fragments are disimpacted; semi-rigid osteosynthesis of fragments is made with wire 26 in the shape of a cross. Once the fracture is fixed, an Erich splint is placed in the maxilla and mandible. It was decided to carry out occlusion and make rigid intermaxillary fixation after 24 hours. Fixation is maintained for eight weeks, activating every seven days, together with masticatory rehabilitation. The patient has a favorable progress, without complications. Occlusion and good mouth opening are restored.