Patients with facial trauma sometimes have life-threatening injuries and complications, and the management of these injuries should be the first medical priority. Major functional problems and unfavorable esthetics may be discovered later because of non-union of osteotomized segments and extensive scar tissue. Therefore, the treatment of these patients is challenging.
We describe the unreported management of an adult patient with a previous traumatic mandibular fracture by using an orthodontic jumping plate and ClassⅡ elastics during distraction osteogenesis. The patient, a 49-year-old male, visited our hospital in 2015 with a chief complaint of malocclusion and esthetic concerns. At the age of 48, he had fallen from the third floor of his house and was taken to a nearby hospital by ambulance because of multiple fractures. After recovering, he underwent open reduction and internal fixation of the mandible; however, he had been left thereafter with malocclusion and a convex profile caused by a condylar fracture. He showed a symmetric face with a convex profile, extensive soft tissue contraction and a limited mouth opening. In addition, he was unable to protrude his mandible at all. The intraoral view showed several missing teeth, an extruded upper left first molar, with overjet and overbite of 9 mm and 7 mm, respectively. He was diagnosed with a retrognathic mandible caused by a previous mandibular fracture.
Orthognathic surgery is a predictable method for improving posttraumatic malocclusion caused by condylar fracture. We were successful in achieving mandibular advancement in the two-stage mandibular distraction for this patient with limited mouth opening and mandibular anterior movement. Treatment was performed with an orthodontic jumping plate and Class Ⅱ elastics for 24 hours during the distraction period to aid mandibular advancement. Nine mm of mandibular advancement was achieved on both the right and left sides, leading to appropriate occlusion. The patient was satisfied with the postoperative occlusion, and the change in profile from convex to straight.
