Mandible and Maxillary

Question 1

Mandible and Maxillary

Answer 1

Open, contaminated fractures. Fractures are often multiple. Comminution often present. Substantial soft tissue trauma. Primary concern is the re-establishment of proper dental occlusion. Consider intubation via a pharyngotomy or tracheostomy when stabilizing complex fractures
Intubate cranial to the hyoid apparatus then suture with a chinese finger trap. Primary concern is the re-establishment of proper dental occlusion

Question 2

Maxillary fractures

Answer 2

Surgical intervention less common. Preservation of the dorsal periosteum and of oral palatine mucoperiosteum. Potential for oronasal fistula formation.
Stabilization: tape muzzel, pins and wire, plates, external fixator, partial maxillectomy.

Question 3

Maxillary fractures treatment

Answer 3

When doing palatine sutures and wires: Major palatine arteries off midline.
Bone plating is very invasive and has a lot of complications. Maxillary bone is very thin and has high irregular topography
External skeletal fixation using acrylic connecting columns

Question 4

Mandibular Fractures

Answer 4

Mandibular symphysis, body, ramus, condyloid process
Considerations: location of the fracture. Configuration. Occlusal surface is the tension surface.
Favorable v unfavorable fractures
Caudal ventral- gravity will be pulling down on the fracture.
Dorsal caudal- may be able to use coadaptation/ tape muzzle.

Question 5

Mandibular Fractures stabilization

Answer 5

Tape muzzle, pins and wires, plates, external fixator, interdental wiring, interdental bonding

Question 6

Mandibular Fractures implants and plating

Answer 6

Want implants on the tensile surface not the compressive. But can’t place the plate dorsally because of the teeth. Mechanically less then optimal.
Plating- best reserved for fractures that can be anatomically reduced.

Question 7

Mandibular Fractures- wires

Answer 7

Circumferential wire around the base/crown of the teeth for adjunctive stability.
Interfragmentary wires (hemicerclage) often not sufficient as sole stabilization
Encircling wires for symphyseal fracture repair
Intramedullary and interfragmentary pins and wire

Question 8

Mandibular Fractures- pins

Answer 8

Fixation pins can be variable diameter and do not need to be linearly aligned

Question 9

Ramus and TMJ injuries

Answer 9

Plates, pins and wires. Tape muzzle, interdental bonding, mandibular- maxillary wiring. Condylectomy
Interdental bonding- Requires intact canine teeth and teeth must be acid etched and dried prior to applying bonding material