Mandibular Fractures Flashcards
type of fracture
simple
compound
comminuted
greeenstick
pathological
muscles attached to the mandible
temporalis
masseter
lateral pterygoid
medial pterygoid
when is a bucket handle fracture seen
seen in edentulous mandibles
bilateral parasymphaseal fractures
extra-oral clinical features
pain
swelling
bruising
trismus
cut lip
otorrhoea
anaesthesia/paraesthesia of lip
intra-oral clinical features
haematoma (FOM)
malocclusion
step deformity
gingival laceration
mobility or loss of teeth
radiographic views to be taken
DPT and PA mandible to allow 3D visualisation
what does a delayed presentation cause
increased risk of complications - wound dehiscence, infection, exposure of hardware, non union or fibrous union
who to refer to
maxillofacial surgery
what is an open technique
fracture margins are visualised intra-orally or extra-orally via an incision
why is the open technique preferred
fracture is immobilised to allow a period of healing
what is the closed technique
fracture margins are not directly visualised
example of closed technique
inter maxillary fixation (wiring the jaws together)
why is closed technique generally not used
there is often mobility at the fracture site that can have a detrimental effect on healing
what does the reduction technique do
aligns the bone ends anatomically
what does fixation technique do
prevents movement of the bone margins whilst healing occurs
methods of open fixation
mini plates
reconstruction plates
compression plates
lag screws
closed methods of fixation
interamaxillary fixation
indications for closed technique
non-displaced favourable fractures
grossly comminuted fractures
significant loss of overlying soft tissue
edentulous mandibular fracures
fracture in children
coranoid process fractures
undisplayed condylar fractures
advantages of closed reduction
inexpensive
simple proceudre
no foreign body so reduced risk of infection
disadvantages of closed reduction
not absolutely stable
prolonged period of IMF up to 6 weeks
possible tmp sequele
decreased oral intake
indications for open reduction
displaced unfavourable fractures
multiple fractures
edentulous displaced fractures
bilateral displaced condylar fractures
advantages of open reduction
improved alignment and occlusion
fracture immobilised
avoid IMF
low rate of non-union
lower rate of infection
disadvantages of open reduction
morbidity of surgical procedure
expensive hardware
need for GA
what are Champy’s principles
placement of plate along the ideal line of osteosynthesis, counteraction distraction forces that occur along the fracture line
why doe edentulous fractures have poor wound healing capacity
poorly vascularised
complications of tx
non-union
altered occlusion
distracted TMJ
scars
infection
necrosis
numb lip
exposed plate
types of condylar fractures
extra-capsular
intra-capsular
for condylar fractures where does the pt deviate to
the side of the fracture
treatment fractured condyle
conservative
- soft diet
-analgesics
action
- open reduction and plating
-closed - Leonard buttons and elastic traction
most common paediatric fracture
condylar most common
conservative management with splints
