📝”What Are Key Concepts of Open Reduction Internal Fixation When Repairing a Parasymphysis Fracture?

- 11.7.24

Quick Review #252 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #ORIF

Managing parasymphyseal mandibular fractures requires careful consideration to avoid complications such as inferior alveolar nerve (IAN) damage, malocclusion, and infection.

1. Anatomical Reduction and Fixation:

• Achieving anatomic reduction is essential to restore mandibular contour, occlusion, and function. Misalignment can lead to complications such as malocclusion and improper healing.

• Rigid fixation techniques, such as miniplates or reconstruction plates, are commonly employed to provide stability and prevent micromovement at the fracture site, which helps prevent malocclusion and ensures bone healing.

2. Avoiding Inferior Alveolar Nerve (IAN) Injury:

• Preoperative imaging, such as a cone-beam computed tomography (CBCT) scan, is crucial for understanding the proximity of the fracture line to the mandibular canal.

• During surgery, meticulous handling of the tissue surrounding the IAN is critical. Excessive traction or manipulation can result in neuropraxia or even permanent nerve injury. For fractures that directly involve the mandibular canal, nerve decompression or transposition may be necessary to avoid compromising nerve integrity.

3. Achieving Proper Occlusal Alignment:

• Correct occlusion is central to functional and aesthetic recovery. Preoperative occlusal evaluation and intraoperative verification with intermaxillary fixation (IMF) or temporary occlusal splints can help maintain proper dental alignment during and after surgery.

• Arch bars or occlusal splints can be used to achieve temporary immobilization, allowing the surgeon to focus on accurate fracture reduction and fixation.

4. Preventing Infection:

• The oral cavity presents a high risk for bacterial contamination, making infection control a priority. Aseptic technique during surgery and the use of perioperative antibiotic prophylaxis are fundamental measures.

• Intraoperative soft tissue handling is vital to minimize trauma, as disrupted or poorly re-approximated tissue can impede healing and raise infection risk.

5. Early Postoperative Mobilization and Follow-Up:

• While rigid fixation allows early mobilization, follow-up is essential to monitor healing, occlusion stability, and nerve function. Immediate post-surgical assessment and regular check-ups can help detect complications early, including delayed healing, infection, or paresthesia.

References:

1. AO Foundation. (n.d.). ORIF, two load sharing plates: Symphysis and parasymphysis - simple. AO Surgery Reference.

2. Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. (Eds.). (2022). Peterson’s Principles of Oral and Maxillofacial Surgery (4th ed.)

3. Fonseca, R. J., Walker, R. V., Barber, H. D., Powers, M. P., & Frost, D. E. (2017). Oral and Maxillofacial Trauma (5th ed.).

4. ChatGPT.2024

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