18 - Mandibular fracture Flashcards
What are the clinical signs and symptoms fo mandibular fracture?
- pain, swelling, limitation of function
- occlusal derangement (occlusal step)
- numbness of lower lip
- loose or mobile teeth
- bleeding (FOM) / sublingual haematoma
- AOB
- facial asymmetry
- deviation of mandible to opposite side
What causes AOB in mandibular fracture?
Bilateral subcondylar fracture
What causes deviation of mandible to the opposite side?
Muscles contract and pull at fractured side
How are mandibular fractures classified? 7
- soft tissue involvement
- number
- side
- site
- direction
- specific
- displacement
How is soft tissue involvement in mandibular fracture classified?
- simple (ST not involved)
- compound (ST involved)
- comminuted (bone shattered ie gun shot)
How is number in mandibular fracture classified?
- single
- double
- multiple
How is side in mandibular fracture classified?
- unilateral
- bilateral
How is site in mandibular fracture classified?
- condyle (intra/extra capsular)
- subcondylar
- coronoid
- ramus
- angle
- body
- parasymphyseal
- alveolar process
How is direction in mandibular fracture classified?
- favourable
- unfavourable (encourages displacement)
How are specific mandibular fractures classified?
- green stick fractures
- pathological fractures
What are green stick fractures?
- common in children
- bone has high organic content
- bone fractures in “stringy” nature
- may not completely separate
How is displacement in mandibular fracture classified?
- displaced
- undisplaced
What factors cause displacement of mandibular fractures?
- direction of fracture line
- opposing occlusion
- magnitude of force
- mechanism of injury
- intact soft tissue (prevents displacement)
- other associated fractures
What is the general management of mandibular fractures?
- clinical exam
- radiographic Assessment
- treatment
- Fast
- immediate OMFS contact
- ABx for open wound
- liquid diet
- analgesics
What makes up the radiographic assessment of mandibular fracture?
- two radiographs at right angles (OPT and PA mandible)
- CT
types:
- OPT : mandibular #
- PA mandible : posterior mandibular #
- Reverse Towne’s : Mand Condylar #
Describe the soft tissue involvement in a fracture of a tooth bearing area.
- compound
- any fracture in the tooth bearing area is compound due to the communication with the PDL
What are the basic principles of mandibular fracture management?
Control pain and infection
- reduction
- fixation
Describe the management of an undisplaced fracture.
- no surgical treatment
- reduction, may not require fixation
Describe the management of a displaced or mobile fracture.
- requires fixation
- closed reduction and fixation (IMF)
- ORIF
Define IMF.
Intermaxillary fixation
Define ORIF.
Open reduction and internal fixation
How long is IMF treatment?
4-6 weeks
How is IMF used in edentulous patients?
Denture is fixed to jaws
What contraindicates IMF?
Epileptics
What are the surgical approaches for fixation of condylar fracture?
- retro-mandibular
- raisdon (inferior border)
- preauricular
- bi-coronal flap
- endoscopic
What are absolute indications for ORIF?
- bilateral subcondylar fracture with AOB
- displaced condylar fracture with trismus
- displaced fracture in middle cranial fossa
- displaced fracture with **occlusal derangement **
- displaced fracture with ramus shortening
