Revision management of infected non-union in bilateral mandibular body fractures in a patient with uncontrolled type 2 diabetes: a case report

Bilateral mandibular body fractures are very uncommon, yet mandibular fractures are among the most common maxillofacial injuries. Patients with systemic comorbidities like diabetes mellitus, which is known to impair immunity, delay wound healing, and increase the risk of surgical infection and non-union, require intricate therapeutic management. This case is noteworthy because it illustrates methods for accomplishing successful results and demonstrates the difficulties in treating post-traumatic, postoperative, infected, non-union Indian diabetic patient. The present case report describes a 40-year-old Indian male with type II diabetes mellitus who sustained bilateral mandibular body fractures. The patient initially underwent open reduction and internal fixation (ORIF) with stainless steel plates elsewhere but subsequently developed secondary infection, pain, swelling, purulent discharge, and bilateral occlusal disharmony. Radiographic assessment revealed non-union with signs of hardware-related complications. The revision surgery involved meticulous debridement, removal of the infected plates, and re-fixation using titanium reconstruction plates along both the superior and inferior mandibular borders. Intraoperative topical vancomycin powder was applied for local antibiotic prophylaxis, and postoperative management included systemic antibiotics and strict glycemic control. Recovery was uneventful, and follow-up exhibited complete resolution of infection with satisfactory occlusion, functional restoration, and esthetic outcomes along with patient satisfaction. Timeline of events: Day 0: facial trauma resulting in bilateral mandibular body fractures Day 5: ORIF with stainless steel miniplates at an outside center postoperative Day 20: onset of pain, swelling, and purulent discharge Day 30: presentation to our outpatient department Day 32: revision surgery with debridement and rigid re-fixation follow-up: 2 weeks, 6 weeks, and 3 months with complete infection resolution. This emphasizes the interplay between systemic disease and local wound factors in mandibular fracture management. It highlights the importance of coordinated multidisciplinary management, including surgical infection control, medical optimization of diabetes, culture-directed antimicrobial therapy, and perioperative anesthetic optimization, in achieving favorable patient-centered outcomes, particularly in individuals with comorbidities such as diabetes mellitus who may be psychologically distressed and demoralized due to prior post-surgical experiences.