Fractures of the mandible Flashcards
What are the clinical signs and symptoms of a fracture of the mandible?
Pain, swelling, limitation of function
Occlusal derangement
–one segment may be dislocated
–unable to close teeth together or not meeting as they used to
Numbness of lower lip
Loose of mobile teeth
Bleeding
Anterior open bite
Facial asymmetry
Deviation of the mandible to the opposite side
What causes deviation of the mandible to the opposite side?
Lateral and medial pterygoid from fracture side will not work properly
How can a fracture of the mandible cause an anterior open bite?
A bilateral fracture around the condyle
The ramus shortens and creates an anterior open bite
What are the classifications of mandibular fractures involving the surrounding bone?
Simple
Compound
Comminuted
What is a simple fracture of the mandible?
Fracture in bone and the surrounding soft tissue is intact
What is a compound fracture of the mandible?
Soft tissue surrounding is damaged, lacerated or exposing the fracture
When is a comminuted fracture of the mandible?
When bone has been broken into multiple small pieces (gunshot wound)
How do you classify the number of fractures of the mandible?
Single
–1 fracture line
Double
–2 fracture lines
Multiple
–3 or more fracture lines
What different sites of a fracture can you have of the mandible?
Angle
Subcondylar
Parasymphyseal (chin area)
Body
Ramus
Coronoid process
Condylar fracture (intra or extra capsular)
Alveolar process
What is a favourable direction of a fracture line?
If the fracture line minimises displacement
What is an unfavourable direction of a fracture line?
If the fracture line encourages displacement
What are green stick fractures?
Happens in children due to organic component of the bones
Bones are softer- fracture happens and does not have complete separation
What are the factors that cause displacement of mandibular fractures?
Direction of the fracture line
Opposing occlusion
Magnitude of force
Mechanism of injury
Intact soft tissue
Other associated fractures
What is the management of mandibular fractures?
Clinical examination
Radiographic assessment
Treatment
What is the treatment of mandibular fractures?
Control of pain and infection
2 basic principles
–Reduction (correct position of fracture)
–Fixation (fix back into correct position)
What is the treatment of an undisplaced fracture?
Surgical treatment
Antibiotics for compound fractures
Soft diet and spontaneous fix
What is involved in a closed reduction & fixation (IMF)?
Depend on patients occlusion to guide reduction
Wire teeth together for 4-6 weeks (intermaxillary fixation) and fracture will repair- fix away from fracture using teeth (liquid diet, hard to keep clean)
What patients are contraindicated for having their teeth wired together (closed reduction & fixation)?
Epileptic patients
Can have a fit and die if they vomit
What is involved in an open reduction & internal fixation (ORIF)?
Expose bony edges surgically- reduce directly with vision and fix into place with screws
Plates made from titanium
When would you not open a fracture?
Infected fracture (adds to infection and healing will be compromised can end up with osteomyelitis)
What are absolute indications for ORIF?
Bilateral subcondylar fracture with anterior open bite tendency
Displaced condylar fracture that interferes with mouth opening
Displaced fracture in the middle cranial fossa
Displaced fracture that causes occlusal derangement
Displaced fracture that causes ramus shortening
What are the pathological causes of a mandibular fracture?
Generalised bone disease- Pagets
Osteogenesis imperfecta
Osteoporosis
Fibrous dysplasia
Hyperparathyroidism
Localised bone disease
–Osteomyelitis
–ORN
–Cysts/odontomes
–Tumours- neoplasma
–Benign/malignant
What does the displacement of fragments depend on?
Pull of attached muscle
Angulation and direction of fracture line
Integrity of periosteum
Extent of comminution
What are some complications of a condylar fractures?
Trismus- clicking and locking
Osteoarthritis
Subluxation
Late trismus
Deviation to affected side
Ankylosis and asymmetry
Open bite
Neurological
Vascular
