title: Treatment of traumatic mandibular nonunion.
abstract: OBJECTIVE
  Nonunion is a complication in mandibular fractures. The causative factors include delay in treatment, infection, inadequate immobilization, and improper internal fixation; concomitant infection may be present. Pain, mobility of the fracture segments, and radiographic evidence of radiolucency did in diagnosis.
  
  
  METHODS
  Three clinical cases are used to present the methods of treatment to manage nonunion following a gunshot wound, assault with a blunt object, and a fall. Treatment included antimicrobial therapy, fracture site debridement, segment immobilization, and bone grafting. Maxillomandibular fixation, debridement, and placement of a reconstruction plate were used in the first case; reconstruction plate, autogenous bone graft in a polyglactin resorbable mesh, and screw buttons in the second; and custom reconstruction plate and iliac crest bone graft in the third.
  
  
  CONCLUSIONS
  All cases healed uneventfully. Due to rapid revascularization, use of autogenous cancellous bone grafts is preferred to cortical bone. Custom-molded polyglactin mesh provides control of the loose cancellous bone graft.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania, 5 White Building, 3400 Spruce Street, Philadelphia, PA, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Bruno
authors.forename: K G
authors.initials: KG
authors.lastname: Kempers
authors.forename: K
authors.initials: K
authors.lastname: Silverstein
mesh_terms: D020341:Absorbable Implants; D000058:Accidental Falls; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001860:Bone Plates; D016025:Bone Transplantation; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D018460:Fractures, Comminuted / Q000601:surgery; D005599:Fractures, Ununited / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D019248:Jaw Fixation Techniques; D008297:Male; D008337:Mandibular Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011098:Polyglactin 910; D013526:Surgical Mesh; D014946:Wound Infection / Q000601:surgery; D014948:Wounds, Gunshot / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D011098:Polyglactin 910