Fractures of the Mandible

Question 1

Which types of mandibular fractures are most common?

Answer 1

• Angle and ramus 33%
• Parasymphysis = 27%
• Condylar process & head = 14%

Question 2

What is the immediate management of a fractured mandible?

Answer 2

ABCDE
Positioning - sat upwards and forwards to maintain airway.
Suction - of secretions and blood
Removal of loose teeth - in line of fracture, may need to be removed with gauze if loose.
Pull fragments forwards - reposition middle segment of mandible anteriorly.
Bridle wire - allows for reapproximation of the segments, improves control of tongue

Question 3

What are the signs of mandibular fracture?

Answer 3

Pain, swelling, bruising, bleeding, limited opening&excursions, open bites, step deformity, mobility, mental nerve anaesthesia, consider any injury to head

Question 4

What are the 3 types of management of a mandibular fracture?

Answer 4

1. Open reduction, internal fixation: when there is gingival tearing and rupture of the PDL, the fracture is considered open due to communication with the oral cavity. RELOCATE the fractured segments and then placing fixation in the form of mini plates and screws onto the bony fragments to stabilise them
2. Intermaxillary fixation: semi ridge metal bars wired to teeth via the embrasures. Used to help with orthodontic traction to guide the occlusion into place.
3. External Fixation: reserved for use in gross fractures with significant bone loss, infection or pathology

Question 5

What are the post-operative instructions for mandibular fractures?

Answer 5

• Occlusion (has this been restored to pre-operative state?)
• Paraesthesia will resolve over time
• Analgesic (regular pain relief required as paracetamol + NSAIDs )
• Soft diet
• Contact sports avoided for 6 weeks after fixation time
• Oral hygiene: soft toothbrush for 2x days cleaning, chlorhexidine or warm salt water rinse

Question 6

What are the complications for mandibular fractures?

Answer 6

• Malocclusion
• Non-union of the bone
• Failure of the fixation
• Infection: inflammation, swelling, flexion at fracture site, exposure of fixation
• Ankylosis: limitation in mouth opening, scarring or tearing os muscles and soft tissue can resist movement, increased osteoclast and osteoblast activity throughout healing can cause condylar head to glenoid fossa