Bone Suture in Management of Mandibular Degloving Injury
A 14-years-old male with a history of “fall” trauma, of his bicycle, experienced soft tissue injuries in the maxillofacial region. The patient, one week later, was referred to the department of Oral and Maxillofacial surgery of Mashhad's university for the management of the lacerated intraoral soft tissue wound in mandibular anterior region.\nIn the extraoral examination, abrasions of the nose, lips, and mentum were present. In addition, the right mandibular incisors had been avulsed. Moreover, silk suture in the lower labial vestibule, from unsuccessful attempts to repair severed mucosa, was noted. Furthermore, debris, necrotic tissue, and exposed bone were present in the vestibular depth [].\nThe patient's hospital discharge card emphasized that tetanus prophylaxis has been introduced. Brain CT scans and orthopantogram were also carried out.\nAfter the administration of local anesthesia (lidocaine 2% with epinephrine 1/80000), debridement of necrotic soft tissue and copious irrigation with high pressure volumes of normal saline was rendered. In the next step, suturing of soft tissue was attempted. Firstly, bone between the left lower canine and lateral lower incisor root was penetrated by a surgical round bur (number 2). Secondly, 3-0 plain gut suture in 26 mm curved needle was modified to straight one so that it can be passed through this hole and exit through the lingual mucosa. By the means of this plain gut suture, the buccal soft tissue flap, 10 mm below free margin, was grasped and sutured to the lingual mucosa []. Likewise, the same procedure was repeated on the right side in the intact bone, apical to the avulsed lateral incisor. The suture knots were placed in the buccal vestibule.\nFurthermore, despite of the intact remaining lower anterior teeth and supporting bone, Essig wiring technique was applied to support the mucosal free edge suturing []. As far as medications are concerned, clindamycin antibiotic 150 mg tabs qid was prescribed for one week. Analgesics (acetaminophen 500 mg) and cholorhexidine mouthwash were also ordered. Additionally, proper manner of tooth brushing was emphasized to the patient and parents.\nThe follow-up, which was carried out for one month after the treatment, has shown excellent results. Consequently, healthy gingiva without scar tissue was noticed [].