Mandibular Angulus Fracture Complicated by Inferior Alveolar Nerve Injury: A Clinical Case Report
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Abstract
Background: Mandibular fractures especially in the angulus area are often accompanied by inferior nervus alveolaris (NAI) injury, resulting in significant complications in the form of sensory disturbances that reduce the patient's quality of life. Optimal management requires proper surgical technique and a thorough understanding of the anatomy and potential complications.
Case: A 40-year-old male patient presented with complaints of severe pain, facial swelling, malocclusion and trismus after falling into a gutter. Clinical and radiologic examination revealed a fracture of the left mandibular angulus with partial rupture of the NAI and avulsion of the lower third molar.
Methods: The patient underwent open reduction and internal fixation (ORIF) with double plate insertion and bone reconstruction with NAI preservation technique. Postoperatively, the patient showed good occlusion stability with no acute complications.
Discussion: Mandibular fractures of the angulus with NAI involvement have a high risk of neurosensory impairment. Recent literature shows a high prevalence of NAI injury in posterior mandibular fractures with variable recovery. Careful operative technique with a nerve preservation approach may decrease the risk of permanent impairment. Studies have also suggested the use of platelet-rich fibrin (PRF) as adjunctive therapy to accelerate nerve regeneration, although it was not used in this case.
Conclusion: This case emphasizes the importance of a careful surgical approach to mandibular angulus fractures with NAI injury. Education regarding the risk of neurosensory complications as well as nerve preservation strategies are key lessons that practitioners should take note of.
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