Abstract
We report a case of mandibular fracture that was operated on without general anesthesia. A 52-year-old man involved in a traffic accident was transferred to the emergency and critical care center of another hospital. Since tension pneumothorax, hemothorax and multiple rib fractures were observed at the primary examination, he was hospitalized in the intensive care unit （ICU）. The next day, acute renal failure with crush syndrome occurred, and dialysis was initiated. He was discharged from the ICU 24 days after hospitalization. As pain in the right mandible inhibited eating, he was referred to our hospital 37 days after the traffic accident. On initial examination, a bone gap at the right mandible angle and hypoesthesia around the right lower lip were observed. Occlusal contact was observed only in the left molars. Radiographs and a computed tomography （CT） scan showed fracture of the right mandible angle. We planned an open reduction and internal fixation surgery for the mandibular fracture under general anesthesia. However, the anesthesiologist's assessment deemed that surgery under general anesthesia was impossible. Bone fragment mobility was observed and therefore maxillomandibular fixation （MMF） using elastic bands was performed. Three days after starting MMF, the bone gap was decreased. In order to start oral intake early, we performed open reduction and internal fixation surgery for the mandibular fracture to the extent feasible under local anesthesia with intravenous sedation. After operation, MMF was restarted. He could ingest liquid food three days after operation, and had good occlusion after nine days. Solid food was reintroduced gradually, and no functional issues in the mandible were observed in the postoperative period. This good condition has been maintained for 15 months after operation. This report demonstrates that open reduction and internal fixation surgery for a mandibular fracture to the extent feasible under local anesthesia with intravenous sedation should be proactively considered instead of conservative treatment if surgery under general anesthesia is impossible, as this can result in early oral intake and reduction of patient stress.
