A POST OPERATIVE CASE ON

MANDIBULAR FRACTURES

Dr.Ruman Banik
MS Resident , Department of Oral And Maxillofacial
Surgery
BSMMU
Particulars Of Patient :

Name : Asad Mia

Age : 50y
Sex : Male
Address : Voirab
District : Kishorgonj .
Reg No :114/1
Bed No : MNP-29
Date of Admission : 3rdAug17
Date of Operation :13th Aug17
Chief complaints :

 Pain in the lower jaw for 15 days .

 Difficulty during taking food.
 Restricted mouth opening from the same duration.
 HISTORY OF PRESENT ILLNESS
 According to the statement of the patient, he fell down
suddenly while doing night duty .
 He had trauma at chin, lower lip and nose region. He had
also given a history of bleeding from the nose and oral
cavity.
 He had no history of vomiting and loss of consciousness .
 He received treatment from a local clinic and was referred

to BSMMU. Now he is admitted in our department for

better management.
 Past Medical History : Nothing significant

 Past Surgical History : Nothing significant

 Drug History : None allergic to any drug or

food
 Immunization History : Partially immunized

 Socio-economic History: Middle class family .

GENERAL EXAMINATION :

Appearance Anxious
Body Build Average
Co-operation Co-operative
Orientation Oriented to time place and
person
GENERAL EXAMINATION
 Anemia
 Jaundice
 Cyanosis ALL are Absent
 Edema
 Dehydration
 SYSTEMIC EXAMINATION

Respiratory system
Cardiovascular system No abnormality
Gastrointestinal system detected
Nervous system
VITALS
 Pulse : 75 beats /min
 BP : 120/75 mm of Hg
 RR : 18 Breaths /min
 Temp : Normal
 LOCAL EXAMINATION
EXTRA ORAL :
 Face is asymmetrical, deviated to
right side.
 Stitch mark on chin, lower lip .
 There is a step deformity at lower
border of mandible at symphysis
region
 Tenderness on palpation right side
of ramus area .
 There is no lateral movement on
right side of TMJ.
INTRA ORAL EXAMINATION

 Occlusal disharmony
 Inter incisal opening is 30 mm.
 Deviation of lower jaw to the right
side.
 Midline shift towards the Right side
 Missing of upper left both premolar
and 2nd molar teeth
.
SALIENT FEATURE
 Mr. Asad mia 50yrs old male hailing from Voirob, ,
Kishorgonj with the complaints of sudden fall
down 15 days back. He had complaints of
difficulty during taking food and unable to close
the mouth completely. Face is asymmetrical,
deviated to right side.
 Stitch mark on chin and lower lip .
 There is a step deformity at lower border of
mandible at symphysis region
 Tenderness on palpation right side of ramus area .
 There is no lateral movement on right side of TMJ.
SALIENT FEATURE

 He is normotensive non diabetic non asthmatic

patient
 He is partially immunized.
 He received treatment in a local clinic and was
referred to BSMMU for better management and he
is now admitted in our department.
INVESTIGATIONS FOR DIAGNOSIS

 Routine Examinations  Specific Examinations

for GA fitness-  OPG
 CBC  Lateral oblique view
RBS
 PA Skull
 S. creatinine , urea
 CT Scan of
 BT , CT
 HbsAg , Anti HCV
Maxillofacial region
 CXR
with 3D Reconstruction
 ECG
OPG :
CT SCAN AXIAL VIEW

Left side
Right side
CT SCAN 3D VIEW
DIAGNOSIS
 Comminuted fracture of mandible.
 TREATMENT PLAN
 Preoperative arch bar wiring
 Open reduction and internal fixation.
 Immobilization of fractured fragment.
SURGICAL APPROACH

 Retromandibular approach for right

ramus .
 Vestibular degloving approach for
symphysis fracture .
PRE OPERATIVE ARCH BAR
WIRING
Thank You For
Listening …
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