PERIOPERATIVE MANAGEMENT OF MANDIBULAR FRACTURES IN A PATIENT WITH SEVERE HYPERTHYROIDISM: A CASE REPORT

Abstract

Purpose: In this report, we had managed to perioperative of mandibular fractures in a patient with severe hyperthyroidism. Methods: A 26-year-old man required emergency admission to the hospital after having a fall and losing consciousness. A computed tomography (CT) scan revealed a fracture line in the mental region and both sides of the condyle. He had a previous history of hyperthyroidism and was prescribed thiamazole, propranolol hydrochloride, and potassium iodide, but he did not take medicine by self-judgement. His laboratory findings were as follows: FT3, 7.53[Formula: see text]pg/mL; FT4, 4.26[Formula: see text]ng/mL; and TSH, undetectable. Therefore, we planned for surgery immediately after his condition improved. We also postponed his maxilla-mandibular fixation (MMF) procedure because there was a probability that MMF procedure caused thyroid crisis. Result: Seventeen days after his injury, he had greatly reduced his risk of having thyroid crisis, he underwent open reduction of his mandibular fractures under general anesthesia. As perioperative management, the patient underwent an opening training and oral care before and after surgery in addition to thyroidal treatment. Conclusion: The procedures prevented adhesion of temporomandibular joint and recovered aperture size. Moreover, we diagnosed agranulocytosis from intraoral lesion and obtained good course in response to early.