Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report

Background The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability. Case presentation A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient’s mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required. Conclusions The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.

Clinical and radiological aspects of mandibular fractures: A review of 128 cases

The objective was to study the epidemiological, clinical and radiological aspects of patients with mandibular fractures in the odontostomatology department at the General hospital Idrissa Pouye in Senegal. This was a retrospective study of the records of patients who came for a mandibular fracture during the period from February 2007 to June 2019 to the odontostomatology department of the General hospital Idrissa Pouye in Dakar. The inclusion criterion was any patient file containing complete information and presenting a mandibular fracture received in the odontostomatology department. We used sociodemographic, clinical and radiographic variables. Of 128 patients who came for consultation with a mandibular fracture, 115 were male and 13 were female. The age group most affected was between 21 and 30 years. Workers (25.2%), pupils and students (25.2%) were the most represented. The most frequent cause of mandibular fractures was road traffic accidents (36.71%). In 41% of the road accidents, Jakarta mopeds were involved. The diagnosis was confirmed by radiological examination, which consisted of an orthopantomogram in 83.5% of cases. The mandibular symphysis was the most frequent location with 40.3% of fracture sites. Total continuity of the lines was observed in 21.9% of cases.

Pattern of isolated mandibular symphysis fracture and trends in management at a tertiary care hospital of Karachi, Pakistan.

Objective: To find the pattern of isolated mandibular symphysis fracture and trends in management at a tertiary care hospital of Karachi, Pakistan. Study Design: Crossectional study. Setting: Department of Oral Surgery, Sir Syed Medical & Dental Hospital-Karachi, Pakistan. Period: January 2018 to December 2019. Material & Methods: Eighty one patients were selected on the basis of inclusion and exclusion criteria. They were diagnosed with isolated anterior mandibular fracture on basis of detailed history, thorough clinical examination and a radiologic investigation (OPG). Etiology of fracture and gender distribution was observed, fracture pattern was observed on basis of helmet wearing. Results: There was a male predilection with a male to female ratio of 4.3:1. Road traffic accident was the commonest cause. 82.7 % of patients were not wearing helmet at time of incidence and 69% from all patients had displaced mandibular fracture which resulted in derranged occlusion. Conclusion: Isolated anterior mandibular fractures is common in younger age group, with a male predilection. Most common etiologic factor is road traffic accident. Displaced fracture pattern is prevalent among patients who were not wearing helmet at time of incidence.

Recovery of Post-Traumatic Temporomandibular Joint after Mandibular Fracture Immobilization: A Literature Review

Considered as one of the most common traumatic injuries of the maxillofacial region, mandibular fractures remain among the complex causes of temporomandibular joint disorders (TMDs). Due to the complexity of the temporomandibular joint, the management of TMDs represents a challenge in real-life practice; although many treatment modalities have already been proposed, ranging from conservative options to open surgical procedures, a consensus is still lacking in many aspects. Furthermore, despite continuous improvement of the management of mandible fractures, the duration of immobilization and temporary disability is not reduced, and the incidence of complications remains high. The aim of the present study is to (i) review anatomophysiological components of temporomandibular joint; (ii) review concepts of temporomandibular joint fractures; and (iii) describe methods of the recovery of the temporomandibular joint after mandibular fracture immobilization.

Treatment of Gunshot-Related Mandibular Fracture with Splint-Guided Reduction: Case Report

Summary Background/Aim: Gunshot injury-related mandibular fractures often have a complex pattern, characterized by comminution, bone loss, and soft-tissue avulsion. The management is difficult and varies between individual cases. Case Report: A 41-year-old male patient presented with marked swelling and ecchymosis in the left mandibular region. Intraorally, he had a deviated open bite on the left side. A unilateral comminuted mandibular fracture was diagnosed by panoramic radiograph and computed tomography. An acrylic dental splint-guided open reduction and internal fixation, including intermaxillary fixation through brackets and intermaxillary elastics, was planned. No complications were observed throughout the healing period, and healing at the fracture site was satisfactory. The occlusion returned to the preinjury position and was stable. Conclusions: This case report shows that successful functional and esthetic results can be achieved with a strict patient-specific treatment protocol for a comminuted mandibular fracture due to gunshot injury.