Medical Science: Updates and Prospects Vol. 10

Background: Mandibular fractures are the most common facial skeletal injuries, often resulting from high-energy trauma, with zygomatic fractures being the second most frequent midfacial injury. Combined fractures of the mandible and zygomaticomaxillary complex typically require open reduction and internal fixation (ORIF) according to most treatment guidelines. However, the question of when closed reduction may be sufficient in such combined injuries remains poorly defined in the literature.

Case Presentation: A 25-year-old healthy male presented after a high-velocity motor vehicle collision (dashboard injury) with a closed, unstable right parasymphysial mandibular fracture (Loukota Type C) and a right zygomatic fracture classified as Knight and North Group VI (complex). Clinical findings included malocclusion with anterior open bite, restricted mouth opening (interincisal distance 15 mm), right periorbital oedema and ecchymosis, conjunctival hyperemia, and infraorbital hypoesthesia (MRC Grade 2).

Management: Both fractures were managed simultaneously under general anaesthesia using only closed reduction techniques. The zygomatic fracture was reduced via a 3 mm percutaneous puncture using a Langenbeck bone hook, achieving an audible click and immediate release of the compressed mandibular condyle (mouth opening increased to 25 mm intraoperatively). The mandibular parasymphysial fracture was reduced by digital manipulation, followed by arch bar application and intermaxillary fixation with elastic traction. Total operative time was 30 minutes.

Results: Postoperative recovery was uneventful. At 2 weeks, mouth opening improved to 35 mm with stable Angle Class I occlusion and no open bite. Infraorbital hypoesthesia improved to Grade 1. By 6 months, mouth opening reached 42 mm, sensation returned to normal (Grade 0), and radiographic bone healing was confirmed. No complications (malunion, nonunion, diplopia, enophthalmos, infection) occurred. Patient satisfaction was 9/10.

Conclusion: Simultaneous closed reduction of a complex zygomatic fracture (Group VI) and an unstable parasymphysial mandibular fracture can achieve excellent functional and aesthetic outcomes without ORIF in carefully selected patients. The key criteria for success include minimal comminution, reducibility of fragments, intraoperative stability, restorable occlusion, and favourable patient factors (young age, non-smoker, good bone quality). This case challenges the automatic indication for open fixation and supports individualised, minimally invasive treatment planning in maxillofacial trauma.