A working paradigm for managing mandibular fractures under regional anesthesia

Abstract

ObjectivesIsolated mandibular fractures contribute to approximately 45% of maxillofacial traumas. Improper management of mandibular fractures can cause myriad potential complications and can lead to serious functional and aesthetic sequelae. The objective of the study is to design a stepwise approach for managing isolated mandibular fractures using open reduction and internal fixation (ORIF) with regional anesthesia on outpatient basis.Materials and MethodsPatients with isolated mandibular fractures presenting to the department of maxillofacial surgery were selected for ORIF under regional anesthesia based on occlusion, age, socioeconomic status, general condition, habits, and allied medical ailments. Standard preoperative, intraoperative, and postoperative protocols were followed. All patients were followed up for a minimum of 4 weeks up to a maximum of 1 year.ResultsOf 23 patients who received regional anesthesia, all but one had good postoperative functional occlusion. One patient was hypersensitive and had difficulty tolerating the procedure. Two patients developed an extraoral draining sinus, one of whom was managed with local curettage, while the other required hardware removal. One patient, who was a chronic alcoholic, returned 1 week after treatment with deranged fracture segments after he fell while intoxicated.ConclusionWith proper case selection following a stepwise protocol, the majority of mandibular fractures requiring ORIF can be managed with regional anesthesia and yield minimal to no complications.

Extraoral approach to a bilateral unfavourable mandibular fracture under local anaesthesia: A case report

“…According to the literature, regional anaesthesia has many advantages over GA, including elimination of GA-related complications such as atelectasis, pulmonary oedema, nausea and vomiting; less need for postoperative nursing care; shorter recovery time; better postoperative pain relief; and reduced treatment cost. 5,10,12 In accordance with previous research, we present the successful management of bilateral atrophic mandible fractures under local anaesthesia in an elder with significant comorbid medical conditions that precluded the administration of GA.…”

“…In 2015, El‐Anwar et al 12 compared the treatment outcomes of parasymphyseal mandibular fractures under regional and GA and concluded that regional anaesthesia could effectively replace GA in selected cases of mandibular fracture, obviating the risks of GA. A more recent study by Chellappa et al 5 involved 23 cases of multiple mandibular fractures, and it was reported that regional anaesthesia was an excellent intraoperative alternative to GA for ORIF of mandibular fractures in selected cases.…”

“…Although nasotracheal intubation is the first choice as it permits intraoperative occlusion control and placement of IMF, submental intubation or tracheostomy may be necessary when nasotracheal intubation is not possible. Apart from all the risks inherent to GA and related to the difficult intubation, significant medical comorbidities of the patient may also preclude the administration of GA. 5 In such cases, it is mandatory to perform the reduction of the fractured mandible under regional anaesthesia. This report describes the management of bilateral fractures in an edentulous, atrophic mandible under local anaesthesia in an elder with significant comorbid medical conditions that precluded the administration of GA.…”

Fractures of the mandible: Epidemiological study of 519 Nigerian cases

“…This technique has been used in the management of fractures involving both the tooth and nontooth bearing portions of the mandible in well-selected patients. [ 24 25 ] It reduces the need for the operating theatre space (because it can be done in the clinic), admission space, and the duration of hospital stay. This translates to the reduced treatment cost for the patient.…”