EMERGENCY STATE OF MANDIBLE FRACTURE MANAGEMENT IN COVID-19 PANDEMIC AREA: A CASE REPORT

  • Vladimir Popovski University Clinic for Maxillofacial Surgery Skopje, Faculty of Dental Medicine, University „ Ss. Cyril and Methodius”, R of North Macedonia
  • Alberto Benedetti University Clinic for Maxillofacial Surgery Skopje, Faculty of Dental Medicine, University „ Ss. Cyril and Methodius”, R of North Macedonia
  • Goran Panchevski University Clinic for Maxillofacial Surgery Skopje, Faculty of Dental Medicine, University „ Ss. Cyril and Methodius”, R of North Macedonia
  • Abdulkerim Bajro University Clinic for Maxillofacial Surgery Skopje, Faculty of Dental Medicine, University „ Ss. Cyril and Methodius”, R of North Macedonia
  • Aleksandar Stamatoski University Clinic for Maxillofacial Surgery Skopje, Faculty of Dental Medicine, University „ Ss. Cyril and Methodius”, R of North Macedonia

Abstract

 “Comminuted” mandibular fracture occurs when a high-energy impact on mandibular or different or multiple regions is applied, with disrupted lines of the lower jaw. Cartographic mapping of the maxillofacial complex should be carefully analyzed by a physician, because the diagnosis is difficult to be established due to facial edema masquerading the clinical features, and in most of the cases abnormal bite. We describe a case of extensively complex comminuted mandibular fracture in symphyseal and parasymphyseal area treated with open reduction, internal fixation and reconstruction in a 20-year-old male patient. Reestablishing function, anatomy and aesthetics were the primary postsurgical goals regarding treatment modality. Immediate blood control was achieved and sound bone healing was confirmed in the second step surgery via extraoral surgery with anatomical landmarks.  Surgical technique regarding fracture repositioning avoiding neurovascular damage and minimal facial scaring resulted with satisfactory occlusion. A follow-up period of 3 months did not show any changes, disadvantages and differences regarding treatment. We have concluded and once again established that the existing and future surgical practice needs to undergo some changes according to proposed algorithms at the time of Covid19 infection.


Keywords: mandible fracture; comminuted fracture; ORIF; craniofacial trauma

References

1.Takahiro Kanno, Shintaro Sukegawa, Yoshiki Nariai, Hiroto Tatsumi, Hiroaki Ishibashi, Yoshihiko Furuki, Joji Sekine. Surgical treatment of comminuted mandibular fractures using a low-profile locking mandibular reconstruction plate system. Ann Maxillofac Surg. 2014 Jul-Dec; 4(2): 144–149. doi: 10.4103/2231-0746.147103
2.Kwonwoo Lee, Kyuho Yoon, Kwan-Soo Park, Jeongkwon Cheong, Jaemyung Shin, Jungho Bae, Inchan Ko, Hyungkoo Park. Treatment of extensive comminuted mandibular fracture between both mandibular angles with bilateral condylar fractures using a reconstruction plate: a case report. J Korean Assoc Oral Maxillofac Surg. 2014 Jun; 40(3): 135–139. Published online 2014 Jun 27. doi: 10.5125/jkaoms.2014.40.3.135

3.Ellis E, 3rd, McFadden D, Simon P, et al. Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg. 2000;58:950–958.
4.Coletti DP, Salama A, Caccamese JF., Jr Application of intermaxillary fixation screws in maxillofacial trauma. J Oral Maxillofac Surg. 2007;65:1746–1750.
5.Ellis E, Zide MF, Manson PN. Surgical approaches to the facial skeleton. Baltimore: Williams & Wilkins; 1995.
6.American Association of Oral and Maxillofacial Surgeons [Internet] Rosemont: American Association of Oral and Maxillofacial Surgeons; c2012. [cited 2012 Jul 7]. Avaiable from: http://www.aaoms.org/
7.Rathna Paramaswamy. Airway management in a displaced comminuted fracture of the mandible and atlas with a vertebral artery injury: A case report. J Dent Anesth Pain Med. 2018 Jun; 18(3): 183–187. Published online 2018 Jun 29. doi: 10.17245/jdapm.2018.18.3.183.
8.Junli Ma, Limin Ma, Zhifa Wang, Xiongjie Zhu, Weijian Wang. The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures: A case report. Medicine (Baltimore) 2017 Jul; 96(27): e7250. Published online 2017 Jul 7. doi: 10.1097/MD.0000000000007250.
9.Cassiano Costa Silva Pereira, Pâmela Letícia dos Santos, Ellen Cristina Gaetti Jardim, Idelmo Rangel Garcia Júnior, Elio Hitoshi Shinohara, Marcelo Marotta Araujo. The Use of 2.4-mm Locking Plate System in Treating Comminuted Mandibular Fracture by Firearm. Craniomaxillofac Trauma Reconstr. 2012 Jun; 5(2): 91–96. Prepublished online 2012 May 8.
10.Eva Gómez Roselló, Ana M. Quiles Granado, Miquel Artajona Garcia, Sergi Juanpere Martí, Gemma Laguillo Sala, Briggitte Beltrán Mármol, Salvador Pedraza Gutiérrez. Facial fractures: classification and highlights for a useful report. Insights Imaging. 2020 Dec; 11: 49. Published online 2020 Mar 19. doi: 10.1186/s13244-020-00847-w
11.John C. Koshy, Evan M. Feldman, Chuma J. Chike-Obi, Jamal M. Bullocks. Pearls of Mandibular Trauma Management. Semin Plast Surg. 2010 Nov; 24(4): 357–374. doi: 10.1055/s-0030-1269765.

12.Joshua J. DeSerres, Sultan Z. Al-Shaqsi, Oleh M. Antonyshyn, Jeffrey A. Fialkov. Best Practice Guidelines for the Management of Acute Craniomaxillofacial Trauma During the COVID-19 Pandemic. J Craniofac Surg. 2020 May 11 : 10.1097/SCS.0000000000006654. Published online 2020 May 11..
13.Mena Said, Victoria Ngo, Joshua Hwang, David B. Hom. Navigating telemedicine for facial trauma during the COVID‐19 pandemic. Laryngoscope Investig Otolaryngol. 2020 Aug; 5(4): 649–656. Published online 2020 Jul 9. doi: 10.1002/lio2.428.
Published
2020-12-25
How to Cite
POPOVSKI, Vladimir et al. EMERGENCY STATE OF MANDIBLE FRACTURE MANAGEMENT IN COVID-19 PANDEMIC AREA: A CASE REPORT. Journal of Morphological Sciences, [S.l.], v. 3, n. 3, p. 107-113, dec. 2020. ISSN 2545-4706. Available at: <http://jms.mk/jms/article/view/166>. Date accessed: 28 jan. 2021.
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Articles