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BDS4 Oral Surgery > Fractures of the Mandible > Flashcards

Fractures of the Mandible Flashcards

1
Q

What is the first thing to consider when patient has suffered from trauma?

A

Airways

Breathing

Circulation

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2
Q

What nerve can damage to the mandible affect?

A

Inferior alveolar nerve
-> presents as numbness in lower lip

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3
Q

What are the clinical signs and symptoms of mandibular fracture

A

Limitation of function- difficulty opening and lateral movement

Occlusal derangement- altered bite, teeth do not interdigitate

Tooth mobility- might be a group of teeth

Bleeding- limited to area where fracture is

AOB- occurs when ramus is shortened by fracture
->Sub-condylar fracture (bilateral)

Asymmetry- deviation of mandible to opposite side

Bleeding in floor of mouth- sublingual haematoma

Step deformity- separation between teeth

Bleeding between the teeth

Condylar fracture- bleeding around the ear

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4
Q

How are mandibular fractures classified?

A
  1. Involvement of soft tissue- simple/compound
  2. Number- single, double, multiple
  3. Side- unilateral, bilateral
  4. Site
  5. Direction of fracture line
  6. Displacement
  7. Specific fractures
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5
Q

What is the difference between simple, compound and comminuted fractures?

A

Simple- if surrounding soft tissue is intact

Compound- if fracture exposed to outside environment (surrounding soft tissue is disturbed- communication/tear within ST)
-> Alters management- required AB

Comminuted- multiple fragments (often caused by gun shot)

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6
Q

What are the different sites a mandibular fracture can occur in?

A

Angle

Sub-condylar region

Para-symphyseal- central region

Body

Ramus

Coronoid

Condyle (intracapsular- within)

Alveolar process

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7
Q

What are the classifications for direction of fracture line?

A

Unfavourable direction- direction of fracture line encourages displacement of fracture

Favourable- limits displacement of fracture

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8
Q

What is a green-stick fracture?

A

Soft bone in children means that the bone doesn’t break completely (attachment within cortices remains)

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9
Q

What are the reasons for pathological fractures?

A

 Osteoporosis
 Osteomyelitis
 Paget’s disease
 Expanding cystic lesion
 Osteogenesis imperfecta
 Hyperparathyroidism
 ORN
 Primary and secondary tumours

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10
Q

Which factors affect displacement of mandibular fractures?

A

Direction of fracture line

Opposing occlusion may prevent unfavourable fracture line from displacing fracture

Magnitude of force- more force is more likely to cause displacement

Mechanism- punch, gun shot, car

Intact ST- displacement is less likely

Other fractures

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11
Q

What are the steps in management of mandibular fractures?

A
  1. Clinical exam
  2. Radiographic assessment- confirm diagnosis
  3. Treatment
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12
Q

How is radiographic assessment of mandibular fractures carried out?

A

If plain (2 at right angles)- OPT and PA mandible
-> others- occlusal, SMV, lateral oblique

Now- mostly using CBCT/CT

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13
Q

Which features are commonly seen radiographs indicate fracture of mandible?

A

Radiolucent lines- can be wide if large displacement

Step deformity on inferior border or occlusion

Loss of posterior continuity

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14
Q

What is the issue with using PA mandible and OPT combination to assess mandibular fracture?

A

Doesn’t give information about medio-lateral displacement

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15
Q

Why is any fracture in teeth bearing area automatically considered compound? What is the significance of this?

A

In contact with PDL and gingival crevice which is in contact with oral cavity

AB required

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16
Q

How are mandibular fractures treated?

A

Control pain and infection- NSAIDS and ABs

-> If undisplaced- no treatment
-> If displaced- closed reduction with fixation (IMF) OR ORIF

17
Q

What is meant by reduction?

A

Reduction- reduce displacement to normal anatomical orientation of fracture segments
 Not required for non-displaced fractures (no treatment required)

18
Q

What is meant by fixation?

A

Fix fragments in place using plates and screws (internal fixation)
 Plates are 2mm thick, screws are 5mm

19
Q

What is meant by closed reduction with fixation?

A

Reduce fracture to normal anatomical orientation without exposing fracture line
-> no cutting patient opening- no periostea exposure
-> done under LA
-> Uses intermaxillary fixation- wiring teeth together

20
Q

What can be done to check mandibular fracture has been reduced to correct position in closed reduction with IMF?

A

Check that teeth are occluding normally- either in perfect occlusion or previous malocclusion

-> look at facets to help

21
Q

What are the drawbacks with closed reduction with fixation?

A

Patient must be on soft diet for 4-6 weeks

Difficulty in OH

Contraindicated in Epilepsy- patients can suffocate if they have a fit

22
Q

What is meant by Open reduction and Internal fixation (ORIF)? (more common option)

A

Reflect tissue with mucoperiosteal flap and expose bone
-> then reduce and fixate
-> done under GA

Uses plates and screw instead of wiring as in IMF

23
Q

What is the issue if a plate/screws are required in lower premolar region?

A

Risks damaging mental nerve

24
Q

What can the issue with a thin atrophic mandible be in the event of fracture? What can be done in this case?

A

Can be too thin to support plate

-> may require bone graft harvested from ribs

25
Q

What are the absolute indications for ORIF in mandibular fracture?

A

Bilateral subcondylar fracture with AOB

Displaced condylar fracture that interferes with mouth opening

Displace fracture in middle cranial fossa

Displaced fracture causing occlusal derangement

Displaced fracture that causes ramus shortening

26
Q

What material are resorbable plates made of ?

A

Polylactic acid- resorbable thermoplastic

27
Q

What treatment is indicated if fracture becomes infected?

A

Closed reduction with IMF

28
Q

What are the surgical approaches used in mandibular fracture surgery?

A

Retro-mandibular approach

Raisdon Approach

Preauricular approach

Bi-coronal flap

Endoscopic reduction and fixation

BDS4 Oral Surgery (19 decks)

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