OPERATIVE REPORT

NAME : LIBAN MOHAMED MOHAMUD

DATE OF PROCEDURE:  13/8/2020
PREOPERATIVE DIAGNOSIS:
mandibular fracture, bilereral parasymphyseal.

POSTOPERATIVE DIAGNOSIS:
mandibular fracture, bilereral parasymphyseal.

OPERATION PERFORMED:
Open reduction and internal fixation of bilateral mandibular fracture with MMF

SURGEON:  SERDAR AKKAY

ANESTHESIA:  General anesthesia via nasal endotracheal intubation.

ESTIMATED BLOOD LOSS:  About 100 mL.

DESCRIPTION OF OPERATION:  The patient was brought into the operating suite and
given general nasotracheal anesthesia. Oral care was given. The patient was then
prepped and draped in the usual sterile and Erich arch bars were adapted to the maxilla
from the first molar to the contralateral first molar and secured with 24-gauge surgical
steel wire on the posterior teeth and 26-gauge surgical steel wire on the anterior teeth.
Same was done on the mandible. The patient was then manipulated up in the maximum
intercuspation and noted to be reproducible. The patient was remanipulated up to the
maximum intercuspation and secured with interdental elastics manner and 0.5%
Marcaine with epinephrine was infiltrated into the areas where incisions were made,
which included the right lower buccal sulcus area and the neck region on the left
side..We then went ahead and exposed the fractures.

An intraoral incision was made first. A small incision was made in the mucosa. This was
done using electrocautery. Dissection was carried through the mucosa, muscle down to
the periosteum. The superior periosteal elevator was then used to expose the fracture.
The fracture was seen. We went ahead and placed some fixation. The OsteoMed
system was used for this. On the proximal side of the fracture, we placed a 6-hole plate.
Three 8 mm screws were placed on the proximal side of the fracture. Superiorly, we
placed a 1.5 plate. Three 5 mm screws were placed on the proximal side of the fracture.
We then went ahead and opened the fracture at the left angle area. Again, an external
Risdon-type incision was made a couple of centimeters below the inferior border of the
mandible. Dissection was carried through the skin down to the platysma. Platysma was
then divided. Then, careful dissection was begun to avoid injury to the facial nerve. The
facial nerve that is the marginal mandibular branch was identified quite nicely.  The
patient had a reaction going on in this area in regards to the soft tissue. It was very
fibrotic and scarred. Due to this, we felt that this fracture is a bit older. Again, we
dissected carefully, not to injure the marginal mandibular branch. We dissected down to
the pterygomasseteric sling. This was divided, gaining access to the mandible. The
periosteum was incised and subperiosteal elevator used to dissect in the subperiosteal
plane to expose the fracture. Again, we ran into the area of preabscess, necrotic tissue.
This area was cleaned out, debrided out and irrigated with copious amounts of normal
saline. We placed a 6-hole plate in the inferior border of this fracture on the proximal
side, three 8 mm screws were placed. The patient was then placed into intermaxillary
fixation with rubber bands with the MMF screws. We then went ahead to place the distal
screws. Again, 3 screws were placed on the inferior plate of the right parasymphyseal
fracture; these were 8 mm screws. This was a 2.0 plate. Two 5 mm screws were placed
into the 1.5 plate. We then placed the 3 distal screws at the angle fracture. These were
8 mm screws.

We then irrigated both incisions with copious amounts of normal saline. The intraoral
incision was closed in 2 layers approximating the muscle with 3-0 Vicryl and the mucosa
with 3-0 chromic. The extraoral incision closed after irrigating again in a multilayer
fashion. The platysmata approximated with 4-0 Monocryl. The subcutaneous
interdermal layer with 5-0 Monocryl and the skin with 5-0 fast-absorbing gut followed by
Steri-Strips. The patient was awoken, extubated and taken to the recovery room in
satisfactory condition, having tolerated the procedure well.