Mandible Fractures and Surgical Approaches Flashcards
most common causes of mandibular fractures
motor vehicle accidents
interpersonal violence
falls
sports injuries
incidence by percentage on location of fracture on mandible
isolated fractures : 70%
unilateral: 53%
angle: 30%
condyle: 23%
symphyses:22%
body: 18%
Ramus: 2%
Coronoid process: 1%
favorable fractures vs unfavorable
favorable:
proximal segment directed in line with distal segment
no vertical or medial displacement of the fracture
common in fractures more anteriorly located in the mandibe
unfavorable:
proximal segment displaced upward and medially
what to include in clinical exam of possible mandibular fracture
changes to occlusion
neurologic exam
movement restrictions
facial asymmetry
lacerations, hematomas, ecchymosis
5 main/ general principles of treatment
re-establish occlusion
antibiotic coverage for open fractures and intact teeth in the line of fracture
attempt to maintain all canines and lone teeth in an arch
extract all non-restorable / hopeless teeth
monitor nutrition
indications for closed reduction ?
general definition
not breaking mucous membrane – physically moving bones back to place without surgically exposing the bone
does not dis-clued use of fixation
- nondisplaced, favorable fractures
- grossly communited with intact periosteum
- significant loss of overlying soft tissue
- edentulous MANDIBLE
- developing dentition (younger pts / children)
- coronoid process fractures
indications for open reduction
- displaced, unfavorable fractures (proximal segment is up and medial)
- edentulous mandible with severe displacement
- multiple facial bone fraactures
- bilateral, displaced condylar fractures
- edentulous MAXILLA
- soft tissue between displaced fracture segments
- when closed reduction is inappropriate
bridle wiring indications?
proper placement includes?
temporary stabilization
prevent more tissue damage
protects airway
prevents pain from segment mobility and muscle cramping
- anesthetize
- reduce segments manually
- pass wire around neck of teeth on either side of fracture
- tighten wire in a clockwise fashion to continue reducing fracture
‘basic’ 6 steps for arch bars
- anesthetize
- measure bar: must be 2 teeth proximal to fractures site
- secure bar by placing wire around second premolars
- place circum-dental wires (24 gauge) for fracture reduction, starting from midline
- for fixation, place box wires (26 gauge)
- ensure proper occlusion before completely tightening wires
signs of condylar fractures
-ipsilateral occlusal prematurity and contralateral open bite
-deviation of mandible towards fractured side opening
- anterior open bite noted with bilateral fractures
- more subtle signs: limited opening, limitations of movements, preauricular pain
ORIF
open reduction / internal fixation
class 1 condylar fracture in terms of
ramus shortening in mm
degree of displacement
treatment
Class 1
ramus shortening - less than 2mm
degree of displacement - less than 10
treatment- closed
class II condylar fracture in terms of
ramus shortening in mm
degree of displacement
treatment
class II condylar fracture:
ramus shortening - 2-15mm
degree of displacement - 10-45 degrees
treatment- ORIF (open reduction internal fixation)
class III condylar fracture in terms of
ramus shortening in mm
degree of displacement
treatment
class III condylar fracture in terms of
ramus shortening - more than 15 mm
degree of displacement - more than 45 degrees
treatment - ORIF
absolute indicators for open reduction in condylar fractures
lateral extracapsular displacement of condyle
malocclusion not amenable to closed reduction (functional reduction of ramus height)