With the patient in dorsal recumbency, the head is supported with a soft pad and the neck extended. The mandible is palpated, and the incision is planned just medial to the mandibular body. A skin incision is performed with a scalpel blade along the ventral margins of the bone and extended as needed to expose the fracture.
The use of electrocautery should be avoided.
2. Option: midline incision
If both mandibles need to be exposed, a single midline incision can be made.
The approach should not be directly over the traumatic wound to avoid unnecessary trauma to the injured area. The exposure should be of sufficient size, so that the surgeon can inspect the wound and reduce the fracture without additional trauma to soft tissue.
The subcutaneous fascia, the platysma muscle and periosteum are incised. The incision ends caudally at the insertion of the rostral belly of the digastricus muscle. It is important to avoid the sublingual branches of the facial artery and vein.
It is important to avoid damaging the mucogingival junction during soft tissues manipulation to prevent perforation into the oral cavity. Care should be taken to retract the middle and caudal mental vessels and nerves.
Closure is done in three layers. The first layer is the periosteum and elevated muscles, then the platysma and subcutaneous tissue, followed by the skin.
Closure of the first two layers is done with absorbable sutures such as 4.0 polyglactin 910 or poliglecaprone 25. The skin is closed with monofilament nonabsorbable sutures in a simple - interrupted fashion.