Oral and Maxillofacial Surgery

Case of the Month


Subjective:

The patient was referred to our practice by the Owensboro Mercy Health System (OMHS) emergency room. The patient presented to the E.R. reporting that he had had a seizure, resulting in a fall, that caused him to strike his jaw.

Objective:

The patient is a 40 y.o. white male allergic to Iodine contrast media. Medications included Dilantin. Multiple admissions for ETOH abuse and depression were noted in his past medical records review. Acute alcohol intoxication was confirmed with a blood ETOH level of 0.14. The patient was a poor historian who frequently visits the E.R. The patient reported that he consumes one pint of vodka per day.

Laboratory data included the following results: 

Dilantin 12.0  (10-20 UG/ML)

Albumin 3.0  (3.4-5.0 GM/DL)
Total Protein 6.2  (6.4-8.2 GM/DL)
Alk Phos 173  (50-136 U/L)
GOT  281  (15-37 U/L)
GPT  143  (30-65 U/L)
Total Bil  2.57  (0-1.50 MG/DL)
LDH 216  (100-190 U/L)
GGT 1088 (15-85 U/L) 

PLTC (platelet count) 92  (150-450 THS/uL)
PT 10.4 MEAN=11.4 sec Range 9.9-12.9
INR .90
PTT 26.2 MEAN=29.0 sec Range 24.0-34.0

Reactive ANTI HAV IGG IGM (+Viral Hepatitis / either active hepatitis or past infection)

Urine Drug Screen + for cocaine and tricyclic anti-depressants

+PPD 
Sputum, no acid fast bacilli seen
Sputum Culture, neg
Oral examination revealed multiple carious teeth, gingival erythema and gingival edema. Bimanual manipulation of the mandible revealed fracture mobility in the left mandibular body region. A 3.0 cm laceration of the lingual alveolar mucosa was noted associated with the fractured edges of the left mandibular body. Sublingual ecchymosis and edema were present. Paresthesia of the mental nerve distribution of the inferior alveolar nerve was noted. Diffuse areas of a cutaneous erythematous rash and bumps were present.

Radiographic examination via lateral oblique and PA (Posterior Anterior) of the mandible confirmed a displaced left mandibular body fracture.

Assessment:

  1. Acute Alcohol Intoxication
  2. Left Mandibular Body Fracture
  3. Dental Caries
  4. Periodontitis
  5. Scabies (Sarcoptes scabiei) Infestation
  6. Depression / Suicidal
  7. Seizure Disorder
  8. Chronic Alcohol Abuse
  9. Alcohol Hepatitis
  10. Alcohol Cirrhosis
  11. Drug Abuse (cocaine)
  12. Non compliant patient

Plan:

  1. Admission to OMHS
  2. Internal Medicine Consultation
  3. Pyschiatry Consultation
  4. I.V. Antibiotics (2 million units of aq PCN q 6 h)
  5. Bath, Kwell (lindane = insecticide) lotion, and Atarax for scabies
  6. Delirium tremens prevention (Thiamine HCL, Librium)
  7. Dilantin
  8. Extraction of teeth numbers 7, 10, 12, 13, 28, 30, 31, and 32
  9. Temporary (in O.R. only - removed in O.R.) Application of Maxillary and Mandibular Arch Bars
  10. Temporary (in O.R. only - removed in O.R.) Application of Intermaxillary Fixation
  11. Extra-oral open reduction and rigid internal fixation of left mandibular body fracture

Results:

A 40 mm four hole Luhr vitallium mandibular compression plate was utilized with one 13 mm screw and three 12 mm screws.
Patient treated by:
  • Dr. Steven R. Tucker Oral and Maxillofacial Surgery 


 Steven R. Tucker DMD, PSC
 Oral and Maxillofacial Surgery
 909 Scherm Road
 Owensboro, KY 42301
 phone: 1-502-926-4107
 fax: 1-502-926-4166
 url: http://www.srt-psc.com

steven@occ-uky.campus.mci.net

Last Modified: July 31, 1997

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