Virtual surgical planning in a rare case of traumatic lateral dislocation of the jaw

Abstract

The present objective study describes a rare case of complex fracture of the mandible with dislocation of the mandibular condyles, treated through virtual surgical planning added to biomodel printing technology. Patient, 23 years old, male, victim of a motorcycle accident, treated at the Goiás Emergency Hospital. On physical examination, he presented mandibular crepitus, open bite and facial asymmetry. Computed tomography detected signs suggestive of comminuted fracture of the mandibular symphysis and bilateral lateral dislocation of the mandibular condyles. The patient underwent open reduction of the mandibular symphysis fracture and closed reduction of the lateral dislocation, but developed malocclusion, limited mouth opening and increased intergonial distance. Due to the complexity of the case, virtual surgical planning was carried out to reduce the mandibular symphysis fracture and conditional repositioning using guidance instructions. The patient underwent a new surgical procedure using guides in three-dimensional biomodels and a pre-molded plate as reduction references. Postoperative physical and tomographic examination showed reestablishment of occlusion, mouth opening and anatomical restoration of the face. Virtual surgical planning has been a fundamental auxiliary tool in managing complex cases in order to optimize preoperative planning and intraoperative execution.