SURGICAL PROCEDURE
The ORIF surgical procedure for comminuted
mandibular fractures was performed 7 to 10 days after
primary debridement. Primary debridement aimed to
stop the bleeding, close the wound in the oral cavity,
clean the area around the fracture regions, and maintain the occlusal relationship using intermaxillary fixation (IMF) under general or local anesthesia. If a
combined maxillary fracture was present, we also performed ORIF for the maxillary fracture during the primary operation to obtain a favorable occlusal relationship (Fig 2). All ORIF surgical procedures were
performed with patients under general endotracheal
anesthesia. The procedure was initiated by making
an extraoral submandibular incision or an incision
along the primary extraoral wound to expose the fractured mandible and fragments and to avoid contact
with the intraoral bacterial conditions. Then, the fractured mandible and the displaced fragments were
reduced. Subsequently, the titanium mesh, with a
thickness of 0.6 mm (Stryker, Kalamazoo, MI), was reshaped according to the morphology of the mandible,
and the reduced bone fragments were fixed with the
reshaped titanium mesh and screws. For some patients, the larger mandibular segments were fixed
with miniplates (Fig 3). During surgery, the restoration
of primary occlusion is a standard procedure for bone
reduction. Finally, the extraoral wound was sutured
layer by layer with No. 3-0 and 5-0 absorbable sutures
and No. 6-0 polyglactin 910 sutures (Vicryl; Ethicon,
Somerville, NJ). Q9 Antibiotic prophylaxis with cefotiam
was used and maintained for all patients for 3 days after
surgery. All patients required IMF for 7 to 10 days after surgery.