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Oral Surgery IV > Management of Mandibular Fractures > Flashcards

Management of Mandibular Fractures Flashcards

(64 cards)

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1
Q

what are the etiologies with percentages of mandibular fractures

A
  • vehicular accidents - 43%
  • assaults - 34%
  • work related causes - 7%
  • falls - 7%
  • sporting accidents - 4%
  • misc 5%
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2
Q

what are the important considerations for the surgeon for a mandibular fracture

A

-anatomy of the mandible and attached muscle
- weakened areas of mandible (area of canine and lower wisdom teeth and condylar neck)
- direction of force of the blow
- age of the patient

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3
Q

what are the types of mandibular fractures

A
  • greenstick fracture
  • simple fracture
  • comminuted fracture
  • compound fracture
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4
Q

what is a greenstick fracture

A

incomplete fracture, periosteum intact (typical in children)

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5
Q

what is a simple fracture

A

does not violate mucosa or skin

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6
Q

what is a comminuted fracture

A

involving multiple fragments of bone which are independently dislocated

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7
Q

what is a compound fracture

A

associated with bone exposure through tissue avlusions

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8
Q

what is the anatomic distribution of mandibular fractures with percentages

A
  • condylar - 29.1%
  • mandibular angle - 24.5%
  • symphysis and parasymphysis (22%)
  • mandibular body (16%)
  • alveolar (3.1%)
  • ascending ramus (1.7%)
  • coronoid (1.3%)
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9
Q

mandible interfaces with skull base via the:

A

TMJ and is held in position by the muscles of mastication

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10
Q

mandible is divided into components with weakest sites being:

A

the third molar area, socket of the canine tooth and the condyle

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11
Q

what are the nerve injuries associated with mandibular fractures

A
  • inferior alveolar nerve through the mandibular foramen and mental nerve through mental foramen
  • damage of inferior dental nerve
  • facial nerve palsy by direct trauma to ramus
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12
Q

what are the muscle attachments to the mandible

A
  • masseter
  • temporalis
  • lateral pterygoid
  • anterior belly of digastric
  • medial pterygoid
    -mylohyoid
  • geniohyoid and genioglossus
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13
Q

what are the muscles of the mandible that cause protrusion

A
  • lateral pterygoid
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14
Q

what are the muscles of the mandible that cause depression/retraction

A
  • digastric
  • genioglossus
  • geniohyoid
  • mylohyoid
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15
Q

what are the muscles of the mandible that cause elevation

A
  • temporalis
  • masseter
  • medial pterygoid
  • lateral pterygoid
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16
Q

what are the muscles of the mandible that cause inward displacement

A
  • lateral pterygoid
  • medial pterygoid
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17
Q

what is the treatment with favorable fractures

A

IMF is acceptable

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18
Q

what is the treatment for unfavorable fractures

A

ORIF is necessary through intraoral or extraoral approach

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19
Q

what are the two classes of fracture of mandible- muscle forces

A

horizontal and verticalw

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20
Q

Motor vehicle accidents can be associated with what fractures

A

multiple comminuted facial and mandibular fx

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21
Q

first assault often results in:

A

single, non-displaced fx

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22
Q

what fracture happens with anterior blow to chin

A

bilateral condylar fractures

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23
Q

angled blow to one side of the parasymphysis can lead to:

A

contralateral condylar or angle fx

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24
Q

clenched teeth during the injury period can lead to:

A

alveolar process fx of the mandible

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25
mandibular fracture may compromise the __________ of the airway in particular with ________
patency; loss of consciousness
26
what can make clinical exam hard
edema, bleeding, patients neurological stability
27
what happens to occlusion after injury
change in occlusion- important to determine pre injury occlusion
28
extra oral examination inspection involves assessment of:
- facial asymmetry - swelling - ecchymosis - laceration - cut wounds - bleeding
29
palpation exam involves:
- elicitation of tenderness - step deformity
30
what does the intra oral exam involve
- anesthesia of the lower lip - abnormal manidbular movement- unable to close or trismus - lacerations, hematomas, ecchymosis - loose teeth - palpation for step defects -bleeding
31
anterior open bite is suggestive of:
bilateral condylar fx
32
posterior open bite is common with:
anterior alveolar process or parasymphyseal fractures
33
unilateral condylar neck fractures are associated with:
open bite on opposite side and deviation of chin towards the side of the fracture during mouth opening
34
what radiographs are indicated for mandibular fx
- plain radiograph: OPG, lateral oblique, PA mandible, AP mandible (reverse Townes), lower occlusal - CT scan - 3D CT imaging
35
what are the stages of healing in secondary bone healing
- hematoma/inflammation - soft callus - hard callus - remodeling
36
secondary bone healing closely resembles:
endochondral ossification
37
describe primary bone healing
involves a direct attempt by the cortex to re-establish itself after interruption without the formation of a fracture callus (open reduction and internal fixation- ORIF)
38
primary healing only works when:
the fracture edges are touching exactly
39
primary bone healing is used for:
rigid surgical fixation as in ORIF or in green stick fractures
40
what are the general principles of treatment
- ensure tetanus prophylaxis -assess nutritional evaluation - mandibular fractures can be considered as an open fracture when they communicate with skin or oral cavity - reduction and fixation - closed vs open - post op monitoring for nausea/vomiting, use or wire cutters - oral care- frequent saline irrigation, good OH, soft toothbrush - weekly exam- hardware, occlusion, weight
41
what is the main objective of treating a mandibular fracture
- restoration of functional alignment of the bone fragments in anatomically precise position utilizing the present teeth for guidance
42
what are the other objectives of mandibular fracture treatment
- normal occlusion is key - anatomical reduction of fragments in good position - immobilization until bony union occurs (IMF = OR - internal fixation with plates and screws - soft tissue repair
43
what are the tx options for mandibular fractures
- no treatment- management with soft diet (greenstick fracture with no displacement) - closed reduction with maxillo-mandibular fixation - open reduction and rigid fixation (ORIF) with plates and screws - open reduction - non rigid fixation with trans- osseous wires - other options: external pin fixation, lag screws, dynamic compression plates
44
________ is necessary prior to rigid fixation
maxillomandibular fixation
45
what is used in closed reduction
- direct wiring - eyelet wiring
46
IMF for how long with closed reduction
6 weeks
47
closed reduction can be performed under:
general or local anesthesia
48
what are the advantages of rigid fixation
- direct bone healing without callus formation - early or immediate post operative function - improved patient comfort and convenience - improved post operative nutrition - improved stabilization of osteotomy segments at the time of surgery - allows elimination of IMF for a period of 4-6 weeks
49
mini plates are always fixed:
monocortically with 2 or 3 screws on each side of the fracture line
50
how is open reduction and rigid fixation with plates and screws for fractured mandible done
- two plates interforaminally - one plate in the angle region; elsewhere: two plates
51
describe mini plating technique in a direct fracture
more and longer plates are needed to bridge defects and stabilize the bone
52
describe mini plating in a comminuted fracture
more and longer plates are needed to stabilize all fragments
53
what is a gunning splint used for
to treat edentulous mandibular fracture
54
what are the considerations with a gunning splint
- rigid fixation is not possible ( poor medical status) - dentures can be used to establish occlusion
55
what is the most feared complication of mandibular fractures in children
ankylosing of the TMJ with impact on jaw growth that causes severe facial deformityh
56
how do you prevent this severe pediatric complication
weekly mobilization
57
what are the treatment options for mandibular fractures in children
- closed reduction - open reduction and fixation - plating at the inferior border - resorbable plates
58
fractures with deciduous dentition can be treated with ____ for ______
MMF for 2-3 weeks
59
why arent rigid techniques used in children
they can harm the tooth bud
60
why is it harder to apply wires around the deciduous teeth
the tooth is closer to the gingival margin than the crown of the permanent tooth
61
may be necessary in pediatric patients to secure the wires to:
the piriform rim and the mandible with circum-mandibular wires
62
what are the complications of manidbular fracture tx
- delayed healing (3%) and non union (1%) - nerve paresthesias (IAN) - malocclusion and mal-union - TMJ problems
63
what is the most common and second most common cause of delayed healing and non union and what are other factors
- most common is infection - second most common cause is noncompliance - other factors: inadequate reduction: metabolic or nutritional deficiency
64
the decision on how to best treat a mandibular fracture is based on:
patient factors, the type of mandibular fracture, the skill of the surgeon and the available hardware

Oral Surgery IV (10 decks)

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