Mandibular Fractures Flashcards
What muscles elevate the mandible?
- temporalis
- masseter
- medial pterygoid
What muscles depress the mandible?
- lateral pterygoid
- geniohyoid
- anterior belly of digastric
What are some clinical signs & symptoms of mandibular fracture?
- pain, swelling, limitation of function
- occlusal derangement
- numbness of lower lip
- loose or mobile teeth
- bleeding
- AOB
- facial asymmetry
- mandibular deviation on opening to opposite side of fracture
What might edentulous patients experience due to mandibular fracture?
Sublingual hematoma [FoM bleeding]
What are the 7 classifications of mandibular fractures?
- Involvement of surrounding tissue
- Number of fractures
- Side of fracture
- Site of the fracture
- Direction of fracture line
- Specific Fractures
- Displacement of the Fracture
How are mandibular fractures classified in reference to involvement of surrounding tissues?
Simple = only involves bone [STs intact]
Compound = surrounding soft tissue lacerated or bone exposed
Comminuted = bone is broken into multiple small pieces
What type of injuries are comminuted fractures?
Gunshot wounds
How are mandibular fractures classified in reference to number of fractures?
- Single
- Double
- Multiple
How are mandibular fractures classified in reference to side of fracture?
Unilateral
Bilateral
How are mandibular fractures classified in reference to site of fracture?
- angle of mandible
- subcondylar
- parasymphyseal
- body
- ramus
- coronoid
- condylar fracture
- alveolar process
How are mandibular fractures classified in reference to direction of fracture line?
Favourable = fracture line minimises risk of displacement
Unfavourable = fracture line encourages displacement
How are mandibular fractures classified in reference to specific fractures?
- green stick fractures
- pathological fracture
What is a green stick fracture?
commonly occurs in children due to their softer, more flexible bones
- occur when one side of the bone bends, causing it to partially fracture, while the other side remains intact
- “greenstick” is derived from the analogy of trying to break a young, green stick from a tree, where the stick bends but does not break completely
How are mandibular fractures classified in reference to displacement of the fracture?
- displaced
- not displaced
What factors can cause displacement of a mandibular fracture?
- direction of fracture line
- opposing occlusion
- magnitude of injury force
- mechanism of injury
- status of soft tissues [if intact, displacement less likely]
- other associated fractures
How are mandibular fractures managed?
- clinical exam
- radiographic assessment
- treatment
How is radiographic assessment of mandibular fractures carried out?
- Initial OPT & PA mandible
- Other views = lower occlusal, lateral oblique, CBCT
How are mandibular fractures treated?
- ALWAYS control of pain & infection [analgesics & antibiotics]
- Decide if pt requires surgical treatment or fixation without surgery
What are the two basic principles of surgical treatment of a mandibular fracture?
- Reduction = put fractured sections into correct anatomical position
- Fixation = keep fracture in displaced position
Displaced or mobile mandibular fractures MUST undergo fixation, what are the two methods of this treatment?
Close Reduction & Fixation
- fracture not opened surgically, dependent on pts occlusion to guide fracture into correct alignment
- involves wiring mouth shut
Open Reduction & Internal Fixation
- expose bony edges surgically, flap raised & reduce them directly with vision
- fixed in place with titanium plates & screws
What medical condition contraindicates mouth wiring procedures?
Epilepsy
- if patient vomits during seizure they will choke
Give examples of specific surgical approaches that can be used to treat mandibular fractures?
- retro-mandibular approach
- raisdon approach
- preauricular approach
- bi-coronal flap
- endoscopic reduction & fixation
