Mandible Open Reduction Internal Fixation

Mandible Open Reduction Internal Fixation (ORIF)

A Mandible ORIF is a maxillofacial surgical procedure used to treat mandibular fractures by exposing the bone, reducing the fracture, and fixing it with plates and screws.

Relevant Anatomy

The mandible consists of the body, angle, ramus, condyle, and symphysis. Vital structures include the inferior alveolar nerve, mental nerve, facial artery and vein, and parotid duct (depending on fracture site).

1. Instruments and Equipment Checklist

Basic Maxillofacial Tray (Sterile)

• Scalpel blades (No. 10, 15)
• Metzenbaum and Mayo scissors
• Adson and DeBakey forceps
• Needle holders
• Periosteal elevators (e.g., Freer)
• Weider or Minnesota retractors
• Langenbeck retractors
• Electrocautery (bovie)
• Suction (Frazier or Yankauer)

Specialised Instruments

• Mandibular plating system (1.5 mm, 2.0 mm mini/micro plates)
• Drill and battery handpiece
• Drill bits (1.5 mm–2.0 mm)
• Depth gauge
• Screwdrivers and taps
• Reduction forceps
• Wire cutters and bone hooks
• Arch bars and wires (if occlusion required)

Sutures

• 3-0 Vicryl for mucosa
• 4-0 Monocryl for skin (if extraoral)

Other Equipment

• Headrest and foam pad
• Eye protection for patient
• Mouth prop or bite block
• Sterile drapes (head-and-neck pack)
• Chlorhexidine mouthwash (for oral prep)
• Gauze rolls or throat pack

Fluids and Medications

• Antibiotics: IV Cefazolin and/or Metronidazole per protocol
• Saline: For irrigation
• Local anaesthetic: Lignocaine with adrenaline for field block or nerve block
• Steroids: Dexamethasone (optional for swelling)

2. Before Knife to Skin

1. Check and arrange instruments and implants
2. Initial count of instruments, swabs, and sharps
3. Confirm imaging and fracture location
4. Ensure plating system is opened and sterilised
5. Apply eye protection and secure airway

Prepping and Draping

• Prep oral cavity with chlorhexidine
• For extraoral approach, prep face and neck with alcoholic chlorhexidine
• Drape with full head-and-neck ENT pack

3. Intraoperative Stages

1. Incision and Exposure: Intraoral or submandibular/retromandibular incision to access fracture site
2. Fracture Reduction: Manually align or use bone hooks and forceps; check occlusion if intraoral
3. Internal Fixation: Drill, measure, and insert screws with mini plates
4. Check Stability: Confirm plate position and fracture stability
5. Irrigation: Clean surgical site with saline thoroughly
6. Closure: Mucosal or layered skin closure with appropriate sutures

4. Post-Op Tasks

• Final count of instruments and sharps
• Apply sterile dressing (if external incision)
• Ensure airway patency and assess bite
• Clean and dispose of oral throat packs
• Document fracture site, hardware used, and occlusion status
• Hand over to recovery with post-op antibiotic and airway plans