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Module 7 > ORAL SURG mandible fracture management > Flashcards

ORAL SURG mandible fracture management Flashcards

1
Q

what are the 2 parts of the condyle?

A

head
neck

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2
Q

where does the lateral pterygoid attach?

A

pterygoid fovea

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3
Q

what anatomical structure is behind the external oblique ridge?

A

ramus of the mandible

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4
Q

what anatomical structure is inferior the the external oblique ridge?

A

angle of the mandible

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5
Q

what foramen are found in the middle portion of the mandible?

A

lingual and mental

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6
Q

where does the mylohyoid muscle attach?

A

oblique line on the lingual surface of mandible

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7
Q

what part of the mandible contains teeth?

A

alveolar process

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8
Q

where does the mentalis muscle attach?

A

mental tubercles

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9
Q

what exits through the mental foramen?

A

terminal branch of the IAN

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10
Q

where is the mental foramen?

A

between apices of premolars

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11
Q

define a fracture?

A

a break or a breach in the continuity of normal anatomical structure of a bone by the application of excessive force resulting in 2 or more fragments of the involved bone

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12
Q

why does the mandible often break in more than 1 place?

A

due to its horseshoe shape

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13
Q

what structure is a known point of weakness?

A

condylar neck (crumple zone)

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14
Q

what is the aetiology of mandibular fractures?

A

assault
sporting injury
RTA
pathological

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15
Q

what types of pathology predispose the mandible to fracture?

A

osteolytic lesions:
cysts
tumours

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16
Q

what are the 5 types of fractures seen in the mandible?

A

simple
compound
comminuted
greenstick
pathological

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17
Q

define a simple fracture?

A

undisplaced
overlying periosteum is intact
radiograph shows crack through cortical layer of bone

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18
Q

describe a compound fracture?

A

perforated through periosteum and often skin
presents externally
involving tooth socket

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19
Q

why do compound fractures predispose mandible to infection?

A

the fracture line runs through the PDL into the oral cavity, exposing mandible to the oral microbiota

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20
Q

describe a comminuted fracture?

A

fracture pattern has multiple fracture lines
bone broken to small fragments

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21
Q

describe a greenstick fracture?

A

uncommon
outer cortices fracture and inner cortex flexes
no displacement

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22
Q

where are the sites in the mandible that can fracture?

A

dento-alveolar
condylar
coronoid
ramus
angle
body
parasymphysis
symphysis

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23
Q

where is the commonest area of fracture to the mandible?

A

condylar neck
angle

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24
Q

why is the condyle known as the crumple zone?

A

instead of driving the condyle into the skull, it will break to prevent damage to the brain

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25
Q

why is the angle of the mandible a point of weakness?

A

the presence of erupted or partially erupted lower 8s

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26
Q

why is the parasymphysis a point of weakness?

A

root of the canine

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27
Q

in what direction does the coronoid process usually displace and why?

A

superiorly due to the temporalis point of attachment

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28
Q

what is the relevance of the muscles attached to the mandible and fractures?

A

dependent on the pattern of the fracture, the muscles can pull the fracture together or apart causing displacement
causes significant pain

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29
Q

in what way do horizontally favourable fractures pull?

A

upwards

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30
Q

in what way do vertically favourable fractures pull?

A

laterally

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31
Q

list the muscles attached to the mandible which may affect the distraction of fracture

A

medial and lateral pterygoid
temporalis
masseter
digastric
geniohyoid
genioglossus
mylohyoid

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32
Q

what direction does the lateral pterygoid displace a condyle fracture?

A

anteriorly and medially

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33
Q

what direction does the temporalis, masseter and med. pterygoid displace a proximal segment fracture?

A

superiorly and medially

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34
Q

what direction does the digastric, geniohyoid, genioglossus and mylohyoid displace the distal segment fracture?

A

inferiorly and posterior

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35
Q

what factors determine the displacement of fractures?

A

pattern of fracture
degree of comminution
teeth in fracture line
muscle pull

36
Q

what makes a fracture unfavourable?

A

muscles pulling them apart

37
Q

what is a bucket handle fracture?

A

seen in edentulous mandibles
bilateral parasymphyseal fractures
anterior segments pulled downwards and backwards

38
Q

in a bucket handle fracture, what muscles pull the anterior segment downwards and backwards?

A

mylohyoid
geniohyoid
digastric
genioglossus

39
Q

what is a guardsman fracture of the mandible?

A

caused by a fall on the midpoint of the chin resulting in fracture of the symphysis as well as both condyles

40
Q

what is a common finding of displaced fracture?

A

malocclusion

41
Q

list the extraoral clinical features of mandible fractures?

A

pain
swelling
bruising
trismus
soft tissue injury: cut lip, dirt, tooth fragment
otorrhoea external auditory meatus tear (may accompany condylar fractures)
anaesthesia/ paraesthesia of the lip

42
Q

list the intraoral clinical features seen with mandible fractures?

A

haematoma in FOM and buccal mucosa
malocclusion
tongue swelling
gingival laceration
mobility/ loss of teeth
fractured teeth

43
Q

what intraoral finding is pathognomic of a fractured mandible?

A

haematoma in FOM/ buccal mucosa (Coleman’s sign)

44
Q

what causes a parasymphyseal step deformity?

A

proximal segment displaced superiorly by muscle pull

45
Q

what may be a sign of an undisplaced fracture?

A

small laceration in gingivae

46
Q

what must be checked when suspicious of an undisplaced fracture?

A

mobility - if there is mobility the fracture will not heal

47
Q

what are the ideal radiographic views for examination of mandible fractures?

A

DPT + PA mandible/ facial

48
Q

when do mandibular fractures merit tx?

A

displacement (mobility noted) and malocclusion

49
Q

what complication arise due to a delay in tx of mandibular fractures?

A

wound dehiscence
infection
exposure of hardware
non-union or fibrous union

50
Q

what time frame should mandibular fractures be treated within?

A

72 hours

51
Q

what happens to a tooth involved in the line of a fracture?

A

it becomes non-vital
needs endo tx

52
Q

what are the 2 types of treatment for mandible fractures?

A

open technique
closed technique

53
Q

describe the open technique for treating mandibular fractures?

A

fracture margins are visualised intraorally or extraorally via an incision

54
Q

why is the open technique preferred for mandible fractures?

A

the fracture is immobilised to allow a period of healing

55
Q

describe the closed technique for treating mandibular fractures?

A

fracture margins are not directly visualised - no incision - intermaxillary fixation (wiring jaws together)

56
Q

in the open technique, describe reduction?

A

aligns the bone ends anatomically
recreates the normal anatomy

57
Q

in the open technique, what is the purpose of fixation?

A

prevents movement of the bone whilst healing occurs

58
Q

describe load bearing fixation in the open technique?

A

100% of the functional load is supported by the fixation e.g., 2 large plates

59
Q

describe load sharing in the open technique?

A

the load is distributed between the hardware and the bone margins e.g., one upper boarder plate and arch bars

60
Q

why do we want fixation in the open technique to be load bearing?

A

not replying on adjacent bone to hold 2 ends together

61
Q

what are the 2 methods of fixation?

A

open
closed (intermaxillary)

62
Q

what is used for the open method of fixation?

A

mini-plates
reconstruction plates
compression plates (old fashioned)
lag screws

63
Q

what materials are used for closed intermaxillary fixation?

A

arch bars
eyelet wires
leonard buttons
cast cap splints
gunning splints

64
Q

what are mini-plates used for and made from?

A

open fixation - made of titanium (they osseointegrate) - they do not get removed

65
Q

when fixating an edentulous mandible, what material do you use?

A

gold reconstruction plates - very rigid

66
Q

list the indications for closed reduction?

A

non-displaced favourable fractures
grossly comminuted fractures
significant loss of overlying soft tissue
edentulous mandible fractures
fractures in children
coronoid process fractures
undisplaced condylar fractures

67
Q

what are the advantages of closed reduction?

A

inexpensive
simple procedure
no foreign body so reduced risk of infection

68
Q

what are the disadvantages of closed reduction?

A

not absolutely stable
prolonged period of IMF up to 6 weeks
possible TMJ sequelae
decreased oral intake
possible pulmonary considerations (aspiration pneuomonia)

69
Q

where do IMF screws engage?

A

labial cortex

70
Q

what is a gunning splint?

A

used for edentulous fractures
anterior teeth removed from denture for oral intake
denture is wired in place for up to 6 weeks

71
Q

what are indications for open reduction?

A

displaced unfavourable fractures
multiple fractures
edentulous displaced fractures
bilateral displaced condylar fractures

72
Q

what are the advantages of open reduction?

A

improved alignment and occlusion
fracture immobilised
avoid IMF
low rate of malunion or non-union
lower rate of infection

73
Q

what are the disadvantages of open reduction?

A

morbidity of surgical procedure
expensive hardware
need for GA

74
Q

what are Champy’s principles?

A

miniplate osteosynthesis = placement of a plate along the so-called ideal line of osteosynthesis, thereby counteracting distraction forces that occur along the fracture line

in the mandibular angle region, this line indicated that a plate may be placed either along or just below the oblique line of the mandible

between the mental foramina, 2 plates are recommended below the apices of the teeth

75
Q

why may extra-oral open reduction be used for edentulous mandible fractures?

A

to avoid stripping the periosteum as it is less vascular

76
Q

what type of plates may you want to use for edentulous mandible fractures?

A

large reconstruction plates that are load bearing

77
Q

what are complications of management of mandibular fractures?

A

non-union, fibrous union, mal-union
altered occlusion
distracted TMJ
scars
infection
necrosis
numb lip
exposed plate

78
Q

what are the 2 types of condylar fractures?

A

extra-capsular
intra-capsular

79
Q

describe an intra-capsular condyle fracture?

A

within the capsule, small fragments

80
Q

describe an extra-capsular condylar fracture?

A

nearer the neck

81
Q

how are condylar fractures usually treated?

A

soft diet and NSAIDs

82
Q

what is TMJ effusion?

A

inflammation

83
Q

what is the treatment for a displaced/ dislocated condylar fracture?

A

open reduction and internal fixation

84
Q

how is a intracapsular condylar fracture treated?

A

closed approach

85
Q

what is of concern with paediatric fractures?

A

tooth germs and condylar growth plates

86
Q

how are paediatric fractures treated?

A

conservative management with splints

Module 7 (33 decks)

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