- Mr. Harminder, aged 45, presented with a history of falling from a height of 15 feet 5 days prior and subsequently losing consciousness for over 2 days. On examination, he had swelling on the right side of his lower face and a lacerated wound on his lower left jaw that was discharging pus. Radiographic imaging showed an undisplaced fracture of the right mandibular body and ramus. Based on the clinical and radiological findings, the diagnosis was of undisplaced fractures of the right mandibular body and ramus regions. The treatment plan involved open reduction and internal fixation surgery for the fractures as well as wound debridement and antibiotic treatment for the infected mandibular wound.

1. CASE PRESENTATION
A Presentation By Dr. Abhijeet
Kamble

2. 2
 Mr. Harminder aged 45 years, first presented to the Deptt. Of
Maxillofacial & Oral Surgery with an A/H/O Fall from a height of
approximately 15 feet on 05-05-2023, at around 9:30 pm near .
• At time of trauma: GCS: 15/15
 H/O LOC (> 2 days), No H/O Vomiting, Seizures-
 No H/O Nasal, Ear bleed-
 H/O Oral bleed+
HISTORY

3. GENERAL
EXAMINATION
GENERAL PHYSICAL
EXAMINATION
3

4. GENERAL EXAMINATION
4
 Pallor: Absent
 Icterus: Absent. Cyanosis: Absent
 Clubbing: Absent
 Pedal edema: Absent
 Lymphadenopathy: Absent
 CNS Examination – WNL
 Cardiovascular Examination – No Abnormality detected
 Respiratory Examination - No Abnormality detected

5.  The patient eventually developed
symptoms associated with alcohol
withdrawal,
- Disorientation wrt time, place and
person.
- Hallucinations.
5 p r e s e n t a t i o n t i t l e 2 0 X X
GENERAL EXAMINATION

6. Extra Oral EXAMINATION
6
 INSPECTION: -
 Face is apparently Asymmetrical, due to
presence of a diffuse swelling wrt Right side
lower half face region
 Sutured laceration measuring around 5x2 cm +
wrt lower left submandibular region + with pus
discharge, lower lip region.
 Eye Movements & Visual acuity : WNL, no
Diplopia seen.
 Mouth opening : restricted, 28 mm
 Mandibular Movements : Painful, Restricted

7. EXTRA ORAL EXAMINATION
7
 PALPATION:-
 Tenderness on palpation+ wrt
Right side preauricular region.
 right Lower body region of the
mandible.
 No Step deformity noted

8.  A pus culture and antibiotic
sensitivity testing was done.
For the pus discharge.
8 p r e s e n t a t i o n t i t l e 2 0 X X
EXTRA ORAL EXAMINATION

9. inTRA ORAL EXAMINATION
9
 INSPECTION:
 MIIO : Reduced, 28mm
 Occlusion: Intact
 No sublingual hematoma noted
 PALPATION:
 Tenderness on palpation+ wrt
Lower right labial sulcular region.
 No Step deformity

10. INTRA ORAL EXAMINATION
1 Occlusion intact
Mouth opening
- Reduced
- 16 mm
2
3
1
2
1 0

11. INVESTIGATIONS
OPG
1 1
- An complete blood investigation was ordered for the patient, - WNL
findings S/O
an – Fracture Right Body
region of the mandible,
Fracture Right Ramus and
Coronoid process of the
mandible.
Others:
ECG,
PA view chest Xray.

12. An NCCT face with a 3D reconstruction was ordered for the patient which was s/o -
Undisplaced FRACTURE RIGHT BODY REGION OF THE MANDIBEL AND A FRACTURE OF
THE RAMUS OF THE MANIDBLE .
CORONAL
VIEW
SAGGITAL
VIEW
AXIAL VIEW
3D CT
1 2
NCCT
FACE
3D CT
INVESTIGATIONS

13. DIAGNOSIS
- Undisplaced
Fracture Right body
region of the
mandible
- Undisplaced Fracture
Right Ramus region of
the fracture
?
1 2
Based upon Clinical and Radiological finding-
1 3

14. Treatment Planning SURGICAL PLANNING
 Undisplaced Fracture Right Body and ramus
region of the mandible.
- Open reduction, Internal fixation.
1 4
 For the infected wound.
- Wound Debridement, Antibiotic coverage.

15. THANK YOU