Bilateral Comminuted Mandibular Fracture Caused by Gunshot Wound: Case Report Using Prototyping to Assist Surgical Planning

Main Article Content

Julia Tavares Palmeira
https://orcid.org/0000-0002-4593-8954
Diego Learth Lima
https://orcid.org/0000-0002-7158-6964
Ricardo Franklin Gondim
https://orcid.org/0000-0002-3246-2299
José Maria Sampaio Menezes Junior
https://orcid.org/0000-0002-7218-3067
Clarice Maia Soares de Alcântara Pinto
https://orcid.org/0000-0002-0209-1482

Abstract

The mandible is one of the facial bones most frequently affected in maxillofacial trauma, and firearm projectiles have shown an increase in incidence among the etiological factors of these fractures. Choosing the optimal timing for surgical intervention is challenging, given the degree of bone comminution and the potential complications that these fractures can present. This paper reports the case of a 36-year-old male patient, with poorly controlled diabetes, admitted to an intensive care unit in a municipal tertiary hospital of the public network in Fortaleza, Ceará, Brazil, as a victim of multiple gunshot wounds. Facial computed tomography showed a comminuted bilateral mandibular body fracture with the presence of metallic structures compatible with projectile fragments. The treatment plan was staged in two surgical phases, beginning with surgical debridement and maxillomandibular fixation. Next, pre-molded 2.4 mm reconstruction plates were installed on a 3D-printed prototype. The patient progressed without complications or clinical complaints and remained under clinical and radiographic follow-up during the postoperative period. Thus, it can be concluded that the use of three-dimensional prototypes for pre-molding reconstruction plates is an excellent tool for achieving proper plate adaptability to the bone profile and for reducing intraoperative time.

Article Details

How to Cite
Tavares Palmeira, J., Lima, D. L., Gondim, R. F., Menezes Junior, J. M. S., & Pinto, C. M. S. de A. (2024). Bilateral Comminuted Mandibular Fracture Caused by Gunshot Wound: Case Report Using Prototyping to Assist Surgical Planning. Brazilian Journal of Case Reports, 5(1), bjcr30. https://doi.org/10.52600/2763-583X.bjcr.2025.5.1.bjcr30
Section
Clinical Case Reports
Author Biographies

Julia Tavares Palmeira, Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF

Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF, Fortaleza, CE, Brazil.

Diego Learth Lima, Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF

Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF, Fortaleza, CE, Brazil.

Ricardo Franklin Gondim, Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF

Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF, Fortaleza, CE, Brazil.

José Maria Sampaio Menezes Junior, Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF

Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF, Fortaleza, CE, Brazil.

Clarice Maia Soares de Alcântara Pinto, Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF

Oral and Maxillofacial Surgery and Traumatology Service, Dr. José Frota Institute - IJF, Fortaleza, CE, Brazil.

References

Siddiqui SU, Iqbal N, Baig MH, Mehdi H, Mahmood Haider S. Efficacy of open reduction and internal fixation in achieving bony union of comminuted mandibular fractures caused by civilian gunshot injuries. Surgeon. 2020 Aug;18(4):214-218.

Da Silva Filho F, Costa MR, da Silva ILI, Vasconcelos RG. Sequelas craniofaciais em vítimas de arma de fogo: uma revisão de literatura. Braz. J. Surg. Clin. Res.2019 Mai; 26(2):85-88.

Maia ABP, Assis SG, Ribeiro FML, Pinto LW. The marks of gunshot wounds to the face. Braz J Otorhinolaryngol. 2021 Mar-Apr;87(2):145-151.

Shvyrkov MB. Primary surgical treatment of gunshot wounds of facial skeleton]. Stomatologiia (Mosk). 2001;80(4):36–40.

Koirala U, Subedi S. Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study. Dent Traumatol. 2021 Apr;37(2):314-320.

Alencar MGM , Rebelo HL, Júnior EZ da S, Junior MAB, Junior MDM. Tratamento de Fratura Complexa de Man-díbula por Abordagem Transcervical: Relato de Caso. Rev Cir Traumatol Buco-Maxilo-Fac Brazilian J Oral Maxillofac. Surg -BrJOMS 2015; 15(4):43-8.

Suomalainen A, Stoor P, Mesimäki K, Kontio RK. Rapid prototyping modelling in oral and maxillofacial surgery: a two year retrospective study. J Clin Exp Dent 2015; 7(5):e605-12

Camino Junior R, Moraes RB, Landes C, Luz JGC. Comparison of a 2.0-mm locking system with conventional 2.0- and 2.4-mm systems in the treatment of mandibular fractures: a randomized controlled trial. Oral Maxillofac Surg 2017; 21(3):327-34.

Fernandes IT, Santos R de M, da Silva NP, Melo I de A, da Rocha ATM, Rodrigues RD, Meireles DGN. Manejo cirúrgico de fratura mandibular cominutiva por projétil de arma de fogo / Surgical management of comminuted mandibular fracture by firearm projectile. Braz. J. Develop. [Internet]. 2021 Aug. 16 [cited 2024 Apr. 28];7(8):81347-61.

Dimic A, Miskovic Z, Jelovac D, Mitrovic R, Ristivojevic M, Majstrovic M. Application of rapid prototyping in maxillofacial surgery. 9th Int Symp Mach Ind Des Mech Eng 2016; 4(January):1-6.

Ren W, Gao L, Li S, Chen C., Li F, Wang QZK. Virtual planning and 3D printing modeling for mandibular reconstruction with fibula free flap. Med. Oral Patol. Oral Cir. Bucal 2018, 23, e359–e366

McAllister P, Watson M, Burke E. A cost-effective, in-house, positioning and cutting guide system for orthognathic surgery. J Maxillofac Oral Surg. 2018;17(1):112-114.

Martelli, N., Serrano, C., van den Brink, H., Pineau, J., Prognon, P., Borget, I., & El Batti, S. Advantages and disadvantages of 3-dimensional printing in surgery: A systematic review. Surgery. 2016:159(6),1485-1500.

Pita Neto IC, Franco JMPL, Junior JL de A, Santana MDR, de Abreu LC, Bezerra ÍMP, et al. Factors Associated With the Complexity of Facial Trauma. J Craniofac Surg 2018; 29(6):e562-6.

Camino Junior R, Moraes RB, Landes C, Luz JGC. Comparison of a 2.0-mm locking system with conventional 2.0- and 2.4-mm systems in the treatment of mandibular fractures: a randomized controlled trial. Oral Maxillofac Surg 2017; 21(3):327-34.

Maharaj S, Mungul S, Laher A. Botulinum toxin A is an effective therapeutic tool for the management of parotid sialocele and fistula: A systematic review. Laryngoscope Investig Otolaryngol. 2020; 5(1):37-45.

Seyhun N, Çalış AB, Turgut S. Penetrating Traumas to the Parotid Region. Sisli Etfal Hastan Tip Bul. 2019 Aug 22;53(3):310-313.

Velasco I, Vahdani S, Ramos H. Low-cost method for obtaining medical rapid prototyping using desktop 3D printing: a novel technique for mandibular reconstruction planning. J Clin Exp Dent. 2017;9(9):e1103-e1108.

Sales PHDH, Cetira Filho EL, Oliveira Neto JQ, Silva JCD, Aguiar ASW, Mello MJR. Rapid Prototyping as an Auxiliary in Mandibular Reconstructions. J Craniofac Surg. 2017 Nov;28(8):e744-e745.

Turek P, Pakla P, Budzik G, Lewandowski B, Przeszłowski Ł, Dziubek T, Wolski S, Frańczak J. Procedure Increasing the Accuracy of Modelling and the Manufacturing of Surgical Templates with the Use of 3D Printing Techniques, Applied in Planning the Procedures of Reconstruction of the Mandible. J Clin Med. 2021 Nov 25;10(23):5525.

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