J Korean Assoc Oral Maxillofac Surg 2018; 44(6): 275~281
A working paradigm for managing mandibular fractures under regional anesthesia
Natarajan Chellappa1, Vikas Meshram1, Prajwalit Kende1, Jayant Landge1, Neha Aggarwal1, Manish Tiwari2
1Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai,
2Private Practitioner, Bengaluru, India
Natarajan Chellappa
Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, P D'Mello Road, St. George Hospital, Near Chhatrapati Shivaji Terminus Area, Fort, Mumbai 400001, India
TEL: +91-022-2262-0668
E-mail: natarajan.balaji.c@gmail.com
ORCID: https://orcid.org/0000-0003-4052-3319
Received December 9, 2017; Revised January 17, 2018; Accepted January 22, 2018.; Published online December 31, 2018.
© Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives: Isolated 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 Methods: Patients 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.
Results: Of 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.
Conclusion: With 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.
Keywords: Mandibular fractures, Regional anesthesia, Complications, Perioperative management, Champy’s lines

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