Management of a Mandible Fracture in a Patient with Osteogenesis Imperfecta Type III with Basilar Invagination and Dentinogenesis Imperfecta: A Case Report

Abstract

Background:

Osteogenesis imperfecta (OI) is a genetic disorder of impaired collagen synthesis leading to bone fragility and a spectrum of craniofacial anomalies. In this case report, we describe the management of a mandibular fracture in a 19-year-old woman with Type III OI who had several complicating factors, including dentinogenesis imperfecta (DI), and basilar invagination.

Methods:

The patient, presented with mandibular pain and occlusal changes following third molar extractions. Imaging revealed a comminuted fracture of the mandibular angle and ramus. Intraoperatively, the patient’s head was immobilized to avoid exacerbating basilar invagination. Hybrid arch bars were used for maxillomandibular fixation (MMF) to accommodate DI, and occlusion was achieved using pre-injury photographs due to difficulty identifying wear facets. A reconstruction plate placed through a Risdon incision secured the fracture, and the patient was placed in dynamic MMF postoperatively.

Results:

The patient tolerated the procedure well, and subsequent surgeries, including Lefort I distraction, were successfully performed using similar protocols for safety.

Conclusion:

This report underlines the importance of individualized management in OI patients, considering their unique skeletal and dental challenges. It also demonstrates that with careful planning and intraoperative adaptations, such as the use of hybrid arch bars and immobilization techniques, complex mandibular fractures in patients with additional anomalies like basilar invagination can be managed effectively.