Mandibular Fractures

Question 1

What type of fracture DOES NOT require treatment?

Answer 1

Undisplaced fractures

Question 2

What may be some clinical SIGNS and SYMPTOMS of a mandibular fracture?

Answer 2

• Pain, swelling, limited function
• Lip numbness
• Bleeding (ear- subcondylar #)
• Sublingual haematoma (edentulous)
• Facial asymmetry
• Occusal derangement
• Loose/ mobile teeth
• AOB
• Mandibular deviation

Question 3

How are fractures classified?

Answer 3

1. Involvement of surrounding tissues
2. Number = single, double, multiple
3. Side = unilateral, bilateral
4. Site
5. Direction = favourable, unfavourable
6. Specific fractures = greenstick, pathological
7. Displacement = displaced, undisplaced

Question 4

What types of tissue involvements are there in a fractured mandible?

Answer 4

1. Simple = soft tissues intact, #
2. Compound = involvement of soft tissues
3. Comminuted = small pieces (gunshot)

Question 5

Where can fractures be seen in the mandible?

Answer 5

1. Condylar
2. Subcondylar
3. Ramus
4. Angle
5. Body
6. Parasymphyseal
7. Symphyseal
8. Alveolar process

Question 6

What causes displacement in fractures?

Answer 6

• Direction of # line
• Opposing occlusion
• Magnitude of force
• Mechanism of injury
• Intact soft tissues

Question 7

What special investigations are required for a fractured mandible?

Answer 7

• RADIOGRAPHS = 2 images!! Taken as right angles to each other

OPT, PA, occlusal, lateral oblique, SMV, CT

Question 8

How are mandibular fractures managed?

Answer 8

• Undisplaced = no tx
• Control pain and infection

SURGICAL

• Reduction = open (expose fracture) or closed (no exposure)
• Fixation = internal (directly on bone) or external
• -> most common = ORIF
• -> CREF (IMF)

Question 9

What are absolute indications for ORIF mandibular fractures?

Answer 9

• Bilateral subcondylar w AOB
• Displaced condylar w mouth opening interference
• Displaced = in middle cranial fossa, with occlusal derangement, causing ramus shortening