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BDS4 CDS Oral Surgery > mandibular fractures > Flashcards

mandibular fractures Flashcards

1
Q

first priorty in any trauma

A

basic life support

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2
Q

have knowledge of

A

muscles of mastication

origin, insertion

aids understanding displacement of #

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3
Q

MoM that help close the mandible

A

medial pterygoid
temporalis
masseter

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4
Q

muscles that push the mandible in the down

A

suprahyoid

mylohyoid
anterior belly digastric

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5
Q

how does displacement of mandibular # occur

A

medial pterygoid, temporalis, masseter will pull the fracture up

whilst the mylohyoid and anterior belly digastric will pull down

DISPLACEMENT

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6
Q

what dictates the pace of management of pt

A

displacement of fracture

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7
Q

other important structures in teh mandible

A

inferior dental nerve - branch of mandibular division of trigeminal (sensation to lower lip, gingivae etc)

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8
Q

possible causes if pt complains of numbess of lower lip

A

trauma
infection
cancer
etc

need to investigate

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9
Q

8 clinical signs/symptoms of mandibular fractures

A
  1. Pain, swelling, limitation of function (unable to open, limitation of side-side movement)
  2. Occlusion derangement (not able to bite normally – bite prematurely, moved from correct position, step deformed)
  3. Numbness of the lower lip
  4. Loose or mobile teeth
  5. Bleeding (limited to area of #)
  6. Anterior open bite – when ramus is shortened, post teeth meet prematurely (bilateral subcondylar fracture)
  7. Facial asymmetry
  8. Deviation of the mandible to the opposite side
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10
Q

possible sites of bleeding which indicate mandibular #

A

FOM - under mucosa=sublingual haematoma
ear
around teeth

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11
Q

classification of mandibular fractures

7 categories

A

involvement of surrounding tissue

number of fractures

side of fractures

site of the fractures

direction of fracture line

specific fractures

displacement of the fractures

used to describe fracture, if more than one – description for each

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12
Q

options for involvement of the surrounding tissue for mandibular fractures

3

A
  1. Simple - # within bone, surrounding soft tissue is in tact
  2. Compound - # exposed to outside, soft tissue no longer in tact
  3. Comminuted – multiple segments
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13
Q

simple fracture

A

within bone, surrounding soft tissue is in tact

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14
Q

compound #

A

exposed to outside, soft tissue no longer in tact

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15
Q

comminuted #

A

multiple segments

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16
Q

number of # options

3

A

single
double
multiple

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17
Q

side of fracture options

2

A

unilateral
bilateral

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18
Q

site of mandibular fracture options

8

A
  1. Angle
  2. Subcondylar
  3. Parasymphsyeal (centre)
  4. Body
  5. Ramus
  6. Coronoid
  7. Condylar fracture (intra-extra capsular)
  8. Alveolar process
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19
Q

direction of fracture line options

2

A
  1. Favourable – direction of # line limits the displacement
  2. Unfavourable – direction of # line encourages displacement
20
Q

specific features of mandibular fractures

2 options

A
  1. Green stick fractures – still attached, soft bone (children), doesn’t completely break
  2. Pathological fractures – osteoporosis, osteomyelitis, paget’s disease, expanding cystic lesion
21
Q

green stick fractures

A

still attached,
soft bone (children)
doesn’ completely break

22
Q

pathological fractures

A

osteoporosis,
osteomyelitis,
paget’s disease,
expanding cystic lesion

23
Q

displaced fractures

A

need surgical intervention

24
Q

undisplaced fractures

A

may not require surgical intervention

25
Q

6 factors that can cause displacement of mandibular fractures

A
  1. Direction of the fracture line – unfavourable then likely to be displaced (not always – opposing occlusion can prevent displacement)
  2. Opposing occlusion
  3. Magnitude of force
  4. Mechanism of injury – single/multiple/size
  5. Intact soft tissue – intact ->unlikely
  6. Other associated fractures – more=higher displacement chance
25
Q

6 factors that can cause displacement of mandibular fractures

A
  1. Direction of the fracture line – unfavourable then likely to be displaced (not always – opposing occlusion can prevent displacement)
  2. Opposing occlusion
  3. Magnitude of force
  4. Mechanism of injury – single/multiple/size
  5. Intact soft tissue – intact ->unlikely
  6. Other associated fractures – more=higher displacement chance
26
Q

3 stages in management of mandibular fractures

A

clinical examination
radiographic assessment
tx

27
Q

radiographic assessment of manidbular fractures must involve

A

parallax

Two radiographs at right angle to each other (OPT +PA mandible)

Other radiographs
a. Occlusal
b. Lateral oblique
c. Town’s view (subcondylar)
d. SMV
e. CT scans – mainly now or CBCT (3D images best)

28
Q

describe fractures here

2

A

right site #, step deformity – right parasymphseal fracture (compound)

left # - angle to coronoid process (likely simple)

any fracture around teeth bearing area is a compound fracture as in direct communication with PDL (and thus gingival crevice)
* need Antibiotics for management

29
Q

3 radiographic characteristic features

to comment on

A

displacement
step deformity
radiolucent

30
Q

tx steps of mandibular fractures

A

control of pain and infection - antibiotics and NSAIDs

2 basic prinicples - reduction and fixation
* undisplaced # = no tx needed
* displaced or mobile # = fixation (surgical intervention)

31
Q

reduction

A

reduce the displacement to its normal anatomical orientation of the # segments (only for displaced fractures)

32
Q

fixation

A

fix in place, commonly plates and screws (internal fixation)

33
Q

options for displaced/mobile #

2

A

closed reduction and fixation (IMF)

open reduction and internal fixation (ORIF)

34
Q

closed reduction and fixation

A

Reduce the fracture segment to normal anatomical orientation without exposure of fracture line
* No periosteal exposure of fracture

Use other guides – e.g. intermaxillary fixation (teeth in occlusion) – need to wire teeth together
* Usually have wear facets to guide you
* Hard to maintain OH
* Soft diet for 6 weeks

35
Q

ORIF (open reduction and internal fixation)

A

reflect soft tissue and expose bone

used mainly now

Exposure of #, reduce with eyes, fix with plates and screws (no need for wiring)
Plates 2mm, screws 5mm
* Kept permanently inside pt mouth

36
Q

issue in osteoporoitic #

A

bone very thin, unable to apply a plate – need a bone graft (harvest from ribs)

can use resorbable metals – polylactic acid, malleable in hot water to adapt to bone and then fix

37
Q

indications for ORIF

5

A

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

38
Q

fixation by

A

plates (semi rigid or rigid)
Interosseous wiring
Upper/lower border
Cortical
Transosseous, circumferential
Screws
Pins/K wires
primary Bone grafting

38
Q

fixation by

A

plates (semi rigid or rigid)
Interosseous wiring
Upper/lower border
Cortical
Transosseous, circumferential
Screws
Pins/K wires
primary Bone grafting

39
Q

6 complication of mandibular #

A

Loss of teeth (loosening)

Delay of union – local infection (plates)
* Mobility of fragment
* Poor reduction
* Soft tissue interposition
* Local pathology
* Old age/debility
* Systemic disease

Malunion

Non union

Late onset trismus

Persisting mental anaesthesia

40
Q

9 complications of condylar fractures

A

Trismus – clicking and locking

Osteoarthritis

Subluxation

Late trismus

Deviation to affected side

Ankylosis and asymmetry

Open bite

Neurological – auriculotemp syndrome
* Mandibular anaesthesia
* VII nerve paresis

Vascular – aneurysms e.g. carotid

41
Q

tx for hairline cracks

condyle #

A

none

42
Q

tx for dentate pts

condyle #

A

interdental eyelet wings, metal arch bars, silver cap splints

avoid surgical intervention for condyle #

43
Q

tx for edentulous pts

condyle #

A

modified dentures, Gunning’s splints

reduction and fixation

avoid surgical intervention for condyle #

BDS4 CDS Oral Surgery (19 decks)

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