Treatment of extended comminuted mandibular fractures with infected cutaneous fistule Post-ORIF using a reconstruction plate: A case report

INTRODUCTION: We report a case of an extended comminuted mandibular fracture using a reconstruction plate, miniplates and arch bar. Cases of extended comminuted mandibular fractures report high rates of complications. In this case, the patient subsequently suffered from an infected cutaneous fistule and non-union of the comminuted segments. CASE REPORT: An 18-year old male arrived at the emergency room after a motorcycle accident with extensive comminuted mandibular fractures extending bilaterally with splitting at the mandibular angle and shattered bony fragments of the alveolus and mandible body. ORIF was performed using a locking reconstruction plate, miniplates and screw followed by maxillomandibular fixation using the arch-bar. Two weeks after the operation, a cutaneous fistule formed in the submental region. After multiple local debridements with little improvement, surgical debridement was done and a small comminuted bone fragment that underwent nonunion was removed. Final evaluation of the patient showed optimal results with satisfactory masticatory function and an acceptable anatomical shape of the lower jaw. DISCUSSION: Extensively comminuted mandibular fractures are known to be difficult to manage. Although the controversy between open versus closed reduction of comminuted mandibular fractures remain, advancements in surgical techniques and equipment has shifted towards open reduction and internal fixation, allowing for better and faster anatomical and functional restoration. CONCLUSION: ORIF should be the treatment of choice in extended comminuted mandibular fractures. A mandibular reconstruction plate can be used to achieve a good results with a relatively faster return of function. Although the incidence of infection in mandibular fractures is high, adequate debridement and plate removal can bring good results as seen in this case. Shifting from closed to open reduction allows the patient to have faster results with less complications in the future.