Segmental Open Mandibular Fracture with Type 2 Diabetes Mellitus Managed by Intraoral Open Reduction, Internal Fixation and 101 Days of Arch Bar Retention: A Case Report with a Structured Care-Gap Analysis
DOI:
https://doi.org/10.37275/bsm.v10i10.1665Keywords:
Diabetes mellitus, type 2, Jaw fixation techniques, Mandibular fractures, Open fracture reduction, Trigeminal nerve injuriesAbstract
Background: Mandibular fracture is the maxillofacial injury most often treated operatively, and road traffic collision is its dominant cause. Published series report fixation technique and union; far fewer report the perioperative variables that govern outcome when a metabolic comorbidity is present.
Objective: To present the staged intraoral repair of a segmental open mandibular fracture in an adult with type 2 diabetes mellitus and, through a structured audit of the record, to identify the measurable perioperative determinants of outcome that were not documented during care.
Case presentation: A 51-year-old man was struck by a car while riding a motorcycle and sustained a multiple open mandibular fracture of the symphysis, right parasymphysis and a segmental right body, with an anterior open bite, an interincisal opening of 24 mm, right mandibular crepitus and an avulsed right mandibular canine. He had treated hypertension and type 2 diabetes mellitus. Computed tomography with three-dimensional reconstruction defined the pattern and excluded condylar and intracranial injury. On the eighth day after injury, intraoral open reduction with four plates was combined with Erich arch bar maxillomandibular fixation. Rigid intermaxillary fixation was released at 21 days and the mandibular arch bar retained for 101 days. At day 116 mouth opening was unrestricted and mastication pain-free, with no infection, dehiscence, malunion or plate exposure. Structured review of the record showed that four determinants of outcome were never documented: any glycaemic measurement, inferior alveolar nerve sensation, the disposition of the avulsed canine and the retained dental roots, and a closing interincisal measurement.
Conclusion: A staged intraoral repair restored occlusion and function in a diabetic adult with a segmental open mandibular fracture. The favourable result was achieved despite four recording gaps, each fixable at no cost, that would have converted a good outcome into a demonstrated one.
Authors
- Deasy Nurwianti1*
- Al Hafiz1
- Tuti Handayani2
- 1Department of Otorhinolaryngology – Head and Neck Surgery, Dr. M. Djamil General Hospital / Faculty of Medicine, Universitas Andalas, Padang, Indonesia
- 2Department of Radiology, Dr. M. Djamil General Hospital / Faculty of Medicine, Universitas Andalas, Padang, Indonesia
Corresponding author Deasy Nurwianti — deasynurwianti@gmail.com
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Copyright (c) 2026 Deasy Nurwianti, Al Hafiz, Tuti Handayani
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