DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Malunion of left parasymphyseal fracture.
POSTOPERATIVE DIAGNOSIS: Malunion of left parasymphyseal fracture.
OPERATION PERFORMED: Mobilization of left parasymphyseal fracture of the mandible with open reduction and internal fixation.
SURGEON: John Doe, MD
ANESTHESIA: General anesthesia via nasotracheal intubation.
ANESTHESIOLOGIST: Jane Doe, MD
DESCRIPTION OF OPERATION: The patient was taken to the OR in stable preoperative condition and was placed on the OR table in the supine position. After successful induction of nasotracheal intubation, the patient was then prepped and draped for a maxillofacial procedure of this nature. Initially, 3 mL of 0.5% Xylocaine with 1:200,000 epinephrine was infiltrated along the left inferior border of the mandible in the body and symphysis regions. Next, the oral cavity was irrigated with copious amounts of sterile saline solution, suctioned dry moist, and a moistened gauze placed in the posterior oropharynx and an oropharyngeal throat pack.
Next, attention was directed to placing arch bars on the posterior dentition. An Erich arch bar was cut and adapted to extend across the right mandibular posterior dentition from tooth #2 to tooth #6. This was ligated to the teeth utilizing 24 gauge stainless steel wires. In a similar fashion, an Erich arch bar was cut and adapted to extend across from tooth #11 to 15 and also ligated to the teeth utilizing 24 gauge stainless steel wires. Then, these wires were twisted, cut, and then twisted down into rosettes. Then, in a similar fashion, Erich arch bars were adapted and ligated to the posterior dentition in both the right and left mandibular quadrants, again utilizing 24 gauge stainless steel wires after the arch bars were stable.
The patient was placed into an approximate pretraumatic occlusion. It was noted that there was an anterior open bite; although, the mandibular teeth #24, 25, and 26 were missing due to the previous extractions. Next, after placing the patient to approximately a Class I occlusion with open bites in the premolar regions, elastics were placed around the mandibular and maxillary Erich arch bars.
Attention was then directed extraorally, where an incision was created in the submandibular region extending from the left body to the mid symphyseal region. This 3 cm incision was carried through skin, subcutaneous tissue, through platysma and mentalis muscles, through periosteum to the bone utilizing a #15 blade through the skin, then electrocautery through the remaining tissues. Next, the periosteum was reflected off the labial aspect of the mandible to expose the previous fracture site. There was noted to be a callous formation at the site. In order to mobilize the fracture segments, a chisel osteotome was used. After the fracture, at the distal and proximal fracture sites, was remobilized, examination intraorally revealed that the elastics had pulled the teeth into tight occlusion with no open bite present. Holding the bone segments in the correct position, a 5-hole Leibinger 2.3 mm plate was adapted across the fracture site. This was held in place utilizing 2.3 mm wide locking screws measuring 14 mm in the distal segment and 12 mm long in the proximal segments.
After these screws were tightened down and the fracture was deemed stable, the area was irrigated with copious amounts of sterile saline solution and suctioned dry. Then, the occlusion was again checked and was again noted to be stable, in tight occlusion with no open bite present. The extraoral incision through the submandibular region was closed in layers utilizing 3-0 Vicryl sutures deep and 5-0 Prolene and a running suture skin closure. The suture line was dressed with a foam elastic dressing as a pressure dressing over the site.
Next, attention was directed intraorally. The elastics were removed. The throat pack was removed. The patient’s bite was reapproximated and noted again that the open bite was closed, and the patient was held in intermaxillary fixation utilizing four 26 gauge stainless steel wires passed around the maxillomandibular Erich arch bars. These wires were twisted tight, then cut and then twisted into his rosettes.
The patient was transported to Recovery, extubated, in stable and satisfactory condition. The patient’s estimated blood loss was approximately 50 mL. The needle and sponge counts were correct at the end of the case. The patient received approximately 1 liter of lactated Ringer’s.
