TREATMENT OF COMMINUTED MANDIBULAR FRACTURE WITH CLOSED REDUCTION AND MANDIBULAR FIXATION VERSUS OPEN REDUCTION AND INTERNAL FIXATION

Lutf Mohammed Al-Rahbi; Mohammed Ali Mohammed Fathael Gamel; Hassan Abdulwahab Al-Shamahy; Ahmed Abdulah Al-Ashwal

doi:10.22270/ujpr.v9i5.1192

Lutf Mohammed Al-Rahbi Department of Oral and Maxillo-Facial Surgery, Faculty of Dentistry, Sana’a University, Republic of Yemen. Yemen Medical Specialist Council, Ministry of Health and population, Yemen.
Mohammed Ali Mohammed Fathael Gamel Yemen Medical Specialist Council, Ministry of Health and population, Yemen.
Hassan Abdulwahab Al-Shamahy Department of Basic Sciences, Faculty of Dentistry, Sana’a University, Republic of Yemen. Medical Microbiology and Clinical Immunology Department, Faculty of Medicine and Health Sciences, Sana’a University, Republic of Yemen.
Ahmed Abdulah Al-Ashwal Department of Oral and Maxillo-Facial Surgery, Faculty of Dentistry, Sana’a University, Republic of Yemen. Yemen Medical Specialist Council, Ministry of Health and population, Yemen.

10.22270/ujpr.v9i5.1192

Keywords:

Close reduction, comminute, gunshot, internal fixation, mandibular fracture, open reduction, Yemen

Abstract

Background and aims: Injuries from firearms remain a serious public health concern, contributing significantly to our society's morbidity, mortality, and costs. Securing an airway, controlling bleeding, determining other injuries, and conclusively repairing the traumatic facial abnormalities are the four primary phases in the care of patients with gunshot wounds to the face. This study aimed to compare the effects of two treatment approaches for mandibular gunshot injuries: closed reduction and maxillomandibular fixation (MMF) against open reduction and internal fixation.

Methods: Between 2020 and 2023, mandibular fractures were found in two equal groups at the Military Hospital in Sana'a, Yemen, where the Department of Oral and Maxillofacial Surgery conducted the study. Twenty patients in group A received treatment by closed reduction and maxillo-mandibular fixation, and another twenty patients in group B received treatment by open reduction and internal fixation. Then complications following surgery were studied. Every patient had made a follow-up call between the second and eighth weeks; following the surgery, both groups' cases of postoperative infection, malocclusion, non-union or malunion of fracture fragments, facial asymmetry, exposed plates, and bone resorption were recorded and assessed radiographically and clinically.

Results: The study analyzed patients with mandible fractures, focusing on G.S.I. and bomb explosions. Most injuries occurred in the body, with parasymphsis being the most common site. Bone exposure was prevalent in 95% of patients. After a two-week follow-up, the ORIF treatment method was associated with more post-operative complications than the CR-MMF treatment method. Wound contraction was more common in the ORIF group (22.5%), followed by bone loss (15%). Plate exposure, nonunion, and malunion were more prevalent in the ORIF group.

Conclusions: In comparison to open reduction with internal fixation, it was determined that closed reduction is the most efficient and dependable management strategy for treating comminuted fractures of the mandible brought on by gunshot injuries. It also has a lower rate of complications.