Management of Mandibular Fracture Malunion: Strategies for Refracture and Realignment | Chapter 4 | Medical Science: Recent Advances and Applications Vol. 10

 

Mandibular fracture malunion represents a complex and challenging sequela, often culminating in significant functional and aesthetic deficits, including malocclusion, facial asymmetry, and impaired mastication. The primary objectives in managing these cases are the restoration of pre-injury dental occlusion, the achievement of stable bony union, and the mitigation of risk factors that predispose to failure. While modern open reduction and internal fixation (ORIF) techniques have improved outcomes, complications such as nonunion, malunion, infection, and hardware failure persist. Key risk factors encompass the severity of the initial trauma (e.g., panfacial fractures, soft tissue loss), technical surgical factors, premature loading, and patient-specific comorbidities like diabetes mellitus and immunosuppression.

 

This chapter provides a comprehensive review of the diagnostic and therapeutic pathways for mandibular malunion. It begins by elucidating the aetiology and biomechanics of malunion, followed by a detailed analysis of preoperative evaluation, emphasising the pivotal role of advanced imaging and virtual surgical planning (VSP) in crafting a precise surgical strategy. The core of the chapter is a detailed exposition of surgical techniques, focusing on the principles of corrective osteotomy, refracture, anatomic realignment, and contemporary rigid internal fixation methods, with critical consideration given to the management of associated soft tissue scarring and neurovascular structures.

 

These principles are vividly illustrated through a detailed case presentation of a 28-year-old male with a malunited mandibular fracture. The case demonstrates the successful execution of a multidisciplinary management plan involving refracture, intermaxillary fixation (IMF)-guided realignment, and ORIF, which successfully restored normal occlusion and masticatory function. The chapter concludes by synthesising key outcomes, post-operative care protocols, and long-term management strategies, offering a structured framework for oral and maxillofacial surgeons to achieve optimal, reproducible results in these demanding reconstructive procedures.

 

 

Author(s) Details

Salem Mohamed Ahmed Eissa Sameh
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy, Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Mekhaeel Shehata Fakhry Mekhaeel
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy, Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Protasov Vitalevitch Andrey
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy, Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Taha Nada Ahmed Mohamed Elsayed
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy, Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Akosua Oppong Gyasi
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy, Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Patience Tendai Matambo
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy, Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v10/6141