ORIF Mandibular Body (Extraoral)

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Preoperative Considerations


  • Scarring
  • Marginal mandibular nerve weakness
  • IAN Weakness
  • Sialocele


  • Hold paralysis if nerve testing


  • Discuss possible need for maxillomandibular fixation


  • Local anesthesia
  • Chlorhexidine or betadine mouth prep
  • Dental extraction instruments PRN
  • #15 blade
  • Monopolar/bipolar electrocautery with Colorado tip
  • #9 periosteal elevator
  • Langenbeck retractors (S,M,L)
  • Drill with fissure bur, pineapple bur
  • Bone reduction forcep
  • Plating system with drill bits, plates, screws. Trocar system PRN
  • Arch bars or means of maxillomandibular fixation
  • 3-0 chromic or vicryl sutures

If Extraoral

  • Nerve stimulator (if extraoral)
  • Vascular clips (S,M)
  • 2-0 or 3-0 silk ties
  • Hemostatic agent
  • Drain (penrose, etc.)
  • 2-0 or 3-0 vicryl sutures
  • Skin sutures i.e. 5-0 plain gut


A person with lines on his neckDescription automatically generated
Preoperative markings demonstrating inferior border of mandible, planned skin incision, and site of mandibular fracture
  • Skin incision is marked in neck crease >2cm inferior to the mandible
  • Perpendicular markings can be made in order to facilitate skin closure after fixation

Postoperative Considerations


  • Check marginal mandibular nerve function
  • Monitor for bleeding
  • Q4 drain check

Follow Up:

  • Monitor occlusion
  • Apply guiding elastics as needed

Operative Note

Surgeon(s): ***

Assistant Surgeon(s):  ***

Preoperative Diagnosis: ***

Postoperative Diagnosis: Same

Procedure(s): ***

Anesthesia: General



Drains: None

Fluids: See anesthesia record

EBL: Minimal

Complications: None

Counts:  Correct x2

Indications: ​***

Findings: As expected

Procedure in Detail:

The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

Attention was first directed intraorally where the fracture was grossly reduced and arch bars were applied. Attention was directed to the neck where a curvilinear incision was made in a skin fold from the angle to midline region. A subplatysmal flap was elevated superiorly till the body of the mandible. The superficial layer of the deep cervical fascia was then sharply incised at the inferior pole of the submandibular gland. The gland was decapsulated and a Hayes-Martin maneuver was performed via ligation of the facial artery and vein with superior reflection along with the fascia in order to preserve the facial nerve. The mandible was then encountered and the periosteum at the inferior border was sharply incised. Dissection was carried out in a subperiosteal plane until fracture segments were identified and manipulated. The patient was then placed into maxillomandibular fixation and the fractured segments were reduced and fixated with a reconstruction plate at the inferior border. The MMF was then released and the occlusion was noted to be stable and reproducible. All sites were irrigated copiously with NS. Surgicell powder was applied. A penrose drain was placed. The neck was then closed in a layered fashion using vicryl and plain gut sutures.

The patient's face was then cleaned and the posterior pharynx was suctioned. Guiding elastics were placed. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.


  • CPT Code 21457: Open treatment of mandibular and/or maxillary alveolar ridge fracture (separate procedure); without internal fixation
  • CPT Code 21461: Open treatment of mandibular subcondylar and/or condylar neck fracture (separate procedure); without internal fixation
  • CPT Code 21462: Open treatment of mandibular subcondylar and/or condylar neck fracture (separate procedure); with internal fixation
  • CPT Code 21480: Open treatment of mandibular body fracture (separate procedure); without internal fixation
  • CPT Code 21485: Open treatment of mandibular body fracture (separate procedure); with internal fixation