Use of a Monoblock Gunning Splint in a Bilateral Condylar Fracture in an Edentulous Patient

초록

This paper presents the outcomes of a conservative approach to a bilateral condylar fracture in an edentulous patient. Serial changes of the inclination angle were measured in an edentulous mandibular fracture treated with a monoblock Gunning splint. After being hit by a motor vehicle, a 67-year-old man fell onto his face. He had been edentulous for 7 years and did not use dentures. His mouth-opening was 28 mm between the edentulous maxilla and the mandible. X-rays and computed tomography revealed a comminuted mandibular angle fracture and bilateral condylar fractures. Stone casts were made from maxillary and mandibular alginate impressions. Maxillary and mandibular labiolingual splints were constructed using an autopolymerizing acrylic resin. In the most comfortable jaw position, the wax-bite was inter-positioned between the upper and lower splints and the vertical dimension was measured. Using a calibration resin, the inter-positional segment containing the eyelet wire was fixed between the splints with glue. A monoblock Gunning splint was applied and intermaxillary fixation (IMF) was performed with circummandibular and circumzygomatic wiring. The inclination of the fractured condyle was compared with the contralateral side. The difference in inclination between the fractured and contralateral sides was plotted over time. On post-IMF day 34, the inclination angle had decreased to 22.9 degrees, only 3.2 degrees greater than the contralateral side. The difference in inclination was fitted to an exponential regression model (y = 11.378e(-0.043x), R-2 = 0.766, P = 0.022). This case shows that a condylar fracture in an edentulous patient can be treated by vertical lengthening using a monoblock Gunning splint and IMF.

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