Case History
10 year old male who was struck by a motor vehicle. His resulting injuries were limited to the maxillofacial skeleton. He sustained a grossly displaced mandibular fracture, multiple avulsed mandibular teeth and multiple avulsed maxillary teeth, and a small facial laceration (Figure 1).
Treatment Options
Treatment options included:
1) Closed reduction and maxillomandibular fixation for 4 weeks
2) Open reduction and internal fixation with traditional mandibular plating systems.
3) Open reduction and internal fixation with a resorbable plating system.
4) Open reduction and internal fixation with lag screw technique.
All treatment options included repair of the facial laceration, intraoral lacerations, alveoloplasty, and extraction or stabilization of the remaining dentition as appropriate.
Operative Stabilization
This patient’s initial management included full history and physical as well as evaluation by the trauma surgery service due to mechanism of injury. A CT scan of the head revealed no intracranial injury and the maxillofacial injuries previously described (Figure 2).
The patient was taken to the operating room on the same day for definitive repair of his fractures and lacerations. His facial laceration was irrigated and repaired, as were his intraoral lacerations. Those teeth deemed nonrestorable were extracted and alveoloplasty was performed in the anterior maxilla. Erich arch bars were applied to the remaining maxillary and mandibular dentition and the patient was placed into maxillomandibular fixation. The mandibular fracture was approached through the existing mandibular gingival laceration. The fracture segments were manually reduced and temporarily stabilized with a modified towel clip (Figure 3).
The fracture segments were then stabilized with 2.4mm screws placed in accordance with the principles of lag screw fixation (Figure 4). His maxillomandibular fixation was then released. The patient had an uneventful postoperative course. He was discharged to home on a mechanical soft diet with follow up scheduled in four days.
Summary
Ellis and others have described lag screw fixation for repair of mandibular fractures. In this case, the oblique nature of the fractures and their anterior location made this technique favorable. The use of a system specific for lag screw fixation contributed to the technical simplicity of this procedure. This fracture was well reduced and well stabilized with this technique as demonstrated by the postoperative radiographs (Figure 5 and Figure 6).
The patient continued to have and uneventful recovery and showed good clinical healing at 6 weeks postoperatively (Figure 7). As there was significant dentoalveolar injury this patient will require future restorative and reconstructive treatment.
References
Ellis E, Ghali GE. Lag Screw Fixation of Mandibular Fractures
J Oral Maxillofac Surg 1991 Jan 49:1 13 - 21.
Kallela I, Ilzuka T, et al.
Lag Screw Fixation of Mandibular Parasymphaseal and Angle Fractures.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996 Nov 82:5 510-6.
Zachariades N, Mezitis M, et al.
Use of Lag Screws for the Management of Mandibular Trauma.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996 Feb 81:2 164-7.