A modified surgical approach to a case of mandibular fracture in a 5-year-old girl
Here is a case of a 5-year-old girl who reported to us 2 days after encountering trauma due to fall from an elevated platform. Clinical examination revealed a discontinuity of the lower border of the mandible on the left side. Her mouth opening was restricted to 10 mm and the mandible was seen to deviate to the left side on opening. Intra oral examination revealed a derangement of occlusion. There was no mobility of the fractured segments. A hematoma was present on the buccal aspect in the parasymphyseal region on the right side []. Further, the orthopantomograph confirmed our clinical observations []. A diagnosis of fracture of the body of the mandible on the left side associated with a fracture of the parasymphysis on the right side of the mandible was made.\nThe treatment approach chosen was a unique one, involving a modification of the conventional transosseous wiring technique. The procedure was carried out under general anesthesia. The body fracture was exposed using a buccal vestibular incision. Two holes were drilled on either side of the fracture line into the buccal cortical plate; one at the region of external oblique ridge to avoid damage to the permanent tooth germ of the first molar and the other close to the lower border of the mandible. Two intermaxillary fixation (IMF) screws with eyelets, 1.5 mm diameter and 10 mm in length were inserted into the holes such that they were perpendicular to the cortical plate following which a 26 gauge stainless steel wire was passed into the eyelets and fastened. Having assuring reduction and fixation of the fractured ends, wound closure was achieved. Fracture reduction and stabilization was concluded satisfactory as shown by the post-operative occlusion. Recovery from general anesthesia was uneventful. An orthopantomograph was made post-operatively to confirm the approximation of the fractured ends []. The patient was discharged on the third post-operative day with instructions for a soft diet and maintenance of good oral hygiene.\nSubsequently, satisfactory healing was observed. Four weeks after placement of the screws, following the confirmation of the stability of the fractured ends both clinically and radiographically a decision was made to remove the screws []. The patient was followed periodically, and presently shows satisfactory occlusion [].