Case Presentation: Bilateral Coronoid Fracture in a 15-Year-Old Boy

Aleena Fatima
Aug 1, 2024
2 min read

Mandibular fractures, particularly in adolescents, can present with unique challenges and require careful evaluation and management. This case presentation details the clinical journey of a 15-year-old boy who sustained a bilateral coronoid fracture following a physical altercation.

Patient Information

Name: ******

Age: 15 Years

Chief Complaint

The patient, a 15-year-old boy, presented with complaints of bleeding in the lower jaw and significant pain, which had persisted for approximately two hours following the injury.

History

Incident: The patient was involved in a physical altercation and subsequently fell onto the road.
Associated Symptoms: No epistaxis (nosebleeds), vomiting, or loss of consciousness was reported.
Medical History: No prior hospitalizations or significant medical history.
Dental History: No previous dental issues were reported.

Clinical Examination

Extra-Oral Examination:

Facial Symmetry: No gross asymmetry observed.
Jaw Movement: Movement of the jaw was notably reduced due to pain.
Palpation: Tenderness was noted on palpation at the angle of the mandible.

Intra-Oral Examination:

Occlusion: Bilateral disturbance in occlusion.
Gingiva: Presence of laceration on the gingiva.

Investigations

A comprehensive evaluation was conducted, including:

ECG (Electrocardiogram): To rule out any cardiovascular issues.
OPG (Orthopantomogram): Essential for assessing the full extent of the mandibular fracture.
Chest X-Ray: To ensure there are no thoracic injuries.
Blood Tests: Routine blood work to assess overall health and readiness for surgery.

Diagnosis

Based on the clinical examination and radiographic findings, a diagnosis of Bilateral Coronoid Fracture was established.

Treatment Plan

Given the nature and severity of the fractures, the following treatment plan was formulated:

Intermaxillary Fixation (IMF): To stabilize the jaw and facilitate proper alignment during the healing process.
Open Reduction Internal Fixation (ORIF): Performed under general anesthesia to accurately align and fixate the fractured segments of the mandible.

Discussion

Bilateral coronoid fractures are relatively rare but can occur due to direct trauma to the lower jaw, as seen in this case. The primary goals of treatment are to ensure proper alignment, restore function, and minimize the risk of long-term complications such as malocclusion or impaired jaw movement.

Intermaxillary Fixation (IMF): This technique is crucial in the initial phase to immobilize the fractured segments, allowing for stabilization and proper healing.

Open Reduction Internal Fixation (ORIF): This surgical approach involves repositioning the bone fragments into their normal anatomical position and securing them with plates and screws. General anesthesia ensures the procedure is pain-free and allows for precise surgical manipulation.

Conclusion

The successful management of bilateral coronoid fractures requires a multidisciplinary approach, involving careful clinical evaluation, appropriate radiographic assessment, and meticulous surgical intervention. This case underscores the importance of timely and effective treatment to ensure optimal outcomes for pediatric patients with mandibular fractures.

Follow-Up

The patient will require regular follow-up visits to monitor healing, ensure proper occlusion, and address any potential complications. Physical therapy may be recommended to restore full jaw function and mobility.

By addressing the injury promptly and comprehensively, we aim to provide the best possible care and facilitate the patient's return to normal activities without long-term sequelae.