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1. A CASE OF RIGHT SUBCONDYLAR AND LEFT PARASYMPHYSIS FRACTURE OF MANDIBLE Guided by: Dr. Vikas Kunwar Singh Sir Professor and Head Dept of OMFS , MGDC, Jaipur Presented By : Pooja Sharma First year resident Dept of OMFS Dr. Ruchika Tiwari Ma’am Professor Dept of OMFS , MGDC, Jaipur

2. CASE HISTORY CHIEF COMPLAINT- Patient name d Rajesh 36 years/male reported to the OPD of Dept of OMFS with chief complaint of pain whil e opening mouth since 1 month

3. CASE HISTORY MECHANISM OF INJURY(M) Patient gives A/h/o fall from stairs on 2/6/24 at around 7:00 Am at home in Gangapur city. No h/o LOC, nausea, vomiting and ear or nose  bleed present H/o oral bleed present (8-10 mins at the time of incident)

4. INJURIES SUSTAINED OR SUSPECTED (I) Local examination Extra oral: Facial Symmetry present Plaster cast placed irt left hand Intra oral: B/L Occlusion deranged Mouth opening - 1.5 finger CASE HISTORY

5. SIGNS AND SYMPTOMS (S) BP- 119/80 mm of hg PR- 76 bpm SpO2- 98% at room air Temperature- Afebrile GCS- E4V5M6 No h/o any known systemic condition s No h/o known drug allergies. M/H- Patient is an operated case of left femur fracture done at RGM hosptal , Gangapur on 3/6/24. CASE HISTORY

6. CASE HISTORY TREATMENT (T) Patient took primary treatment for left femur fracture and plaster cast placement irt left hand on 3/6/24 at RGM Hospital Gangapur . No intervention for facial fractures were done only 3DCT scans were taken.

7. PRE OPEARTIVE FINDINGS

8. PRE OPEARTIVE FINDINGS

9. Right subcondylar fracture and left Parasymphysis fracture of mandible FINAL DIAGNOSIS

10. TREATMENT OPTIONS- Conservative Management Analgesia Antibiotics Soft diet A ctive Managemnt Open/closed reduction & fixation Immobilisation with IMF Rehabilitation Physiotherapy TREATMENT PLANNING

11. Establishment of occlusion Arch bars and maxillomandibular fixation (MMF) are almost always necessary to establish the premorbid relationship of the mandibular and maxillary teeth. Erich arch bars and wire loop maxillomandibular fixation are commonly used in this technique. Approach and exposure The most common approach is the t ransoral gingivolabial and gingivobuccal incision . For larger, comminuted fractures an external approach 2 fingers below mandible is given (to avoid injury to marginal mandiblular N). Fracture can also be exposed from existing laceration

12. Plating Technique Once the fracture is reduced and the angles have been squeezed together, plates are applied for fixatio n . The fracture is reduced with the bone reduction forceps and manual compression of the mandibular angles to avoid flaring. If the arch bars are going to be removed, a monocortical tension band is then applied to the upper Champy line using a 4 to 5 hole, 2.0-mm plate, and 4- to 5-mm screws

13. Plating Technique The lower border bicortical plate is then applied. The drill holes are made adjacent to the fracture one at a time and the drill guide is utilized to measure the thickness of the bone. A minimum of 2 holes are needed on either side of the fracture for stable fixation.

14. D. Gregory Farwell, Management of symphyseal and parasymphyseal mandibular fractures, Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 19, Issue 2, 2008, Pages 108-112,ISSN 1043-1810, https://doi.org/10.1016/j.otot.2008.06.001.

15. Hatwar VA, Kulkarni CA, Patil S. Rehabilitation and Management of Complex Multiple Para- Symphysis Mandible Fracture: A Case Report. Cureus . 2022 Nov 7;14(11):e31180. doi : 10.7759/cureus.31180. PMID: 36505157; PMCID: PMC9727580.

16. INTRA OPERATIVE PHOTOS

17. POST OPERATIVE PHOTOS

18. THANK YOU !