Background
Para/symphyseal mandibular fractures can require three skilled operators; one for fracture reduction, another for suction and a further for placing/fixing osteosynthesis plates. Use of bone reduction forceps can help reduction and fixation of mandibular fractures. They facilitate precise anatomical reduction and fewer post-operative complications.1 We demonstrate an alternative method, utilising instruments found on a standard surgical trauma tray, allowing self-retention, reduction and retraction.
Technique
A mucoperiosteal flap is raised exposing the fracture. Two burr holes are made either side of the fracture, halfway down the mandibular vertical height for even fracture reduction force (Fig 1). Curved artery forceps are inserted to engage the holes (to 5-6mm depth, avoiding nerves) and closed on a ratchet. Then, an Obwegeser periosteal elevator is placed below the lower border, resting on the lower lip. The forceps ratchet is rested on the elevator shank, creating a self-retaining retractor with bone reduction (Fig 2).
Figure 1.
Clinical photo demonstrating burr holes made either side of the fracture line, halfway down the mandibular vertical height
Figure 2.
Curved artery forceps engage the burr holes and close on a ratchet. An Obwegeser periosteal elevator is placed below the lower border, resting on the lower lip. The forceps ratchet is rested on the elevator shank, creating a self-retaining retractor with bone reduction
Discussion
Use of reduction-compression forceps in reducing mandibular fractures has successful outcomes.2 However, there are few references regarding their use.1-5 They have advantages including three-dimensional positioning and compression of bone fragments, and the reduced need for perioperative IMF.2 This technique means the surgeon has both hands free to place fixation and allows good vision/access to the fracture site. Although crazing at burr hole sites has been reported in a laboratory study, this has not been found in clinical practice.5
References
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