What are the signs and symptoms of a mandibular fracture?
-Numbness – ID nerve
What is this?
An atrophic mandible
What are the common sites for mandibular fractures?
What does a ring fracture look like?
What are the principles of fracture management?
What are the methods of treating fractures?
•Conservative fracture - undisplaced: Indirect fixation
–IMF : eyelets, archbars, buttons, IMF screws etc
–External : pins & frames
–Internal : Miniplates or reconstruction plates
What is miniplating?
A way of treating simple fractures.
•Minimises healing time
•Restores early function at # site
ie speech, deglutition and mastication
•Prevents infection by mechanical movements
What is the most common combination of fractures?
The most common combination of fractures is an angle combined with a contralateral fracture through the body or symphysis.
What are the signs of a mandible fracture of the condyle?
Bleeding in the external meatus
What are the different forms of fracture?
What do you have to be careful of in an atrophic mandible?
In the severely atrophic mandible, even very minor trauma can cause fracture. Often, these fractures occur bilaterally.
Orthopantomogram (OPG), mandible series radiograph and CT scans can be used to diagnose and plan the treatment.
What are the clinical signs of edentulous atrophic fractures?
Extraoral ecchymosis pain and mobility of the anterior mandible.
Intraoral ecchymosis in the floor of the mouth associated with an atrophic edentulous mandible fracture.
What are the indications for the removal of teeth in the line of fracture?
Tooth luxated from its socket and/or interfering with reduction of the fracture.
Tooth that is fractured (as illustrated).
Tooth with advanced dental caries carrying a significant risk of abscess during treatment.
Tooth with advanced periodontal disease with mobility which would not contribute to establishment of stable occlusion.
Tooth with existing pathology such as cyst formation or pericoronitis.
What are the indications to leave teeth in the line of fracture?
Tooth that does not interfere with reduction and fixation of fracture.
If tooth removal requires removal of excessive amount of bone so as to compromise the fracture site and possible plate/screw fixation.
Tooth that is in good condition and assists in establishing occlusion and reducing the fracture.
What are the possible clinical signs for midfacial fractures?
Facial swelling (edema, hematoma, emphysema) (see picture), and deformity
Subconjunctival bleeding (hyposphagma)
Palpable and crepitating dislocated bony contour in the periorbital region
Displacement of the globe (hyper-, hypo-, eno-, exophthalmos)
Displacement of the medial canthal tendon (depending on the degree of NOE fracture)
Compromised ocular motility
Sensory deficit (hypoesthesia, anesthesia, paresthesia) of the trigeminal nerve
CSF leakage (in case of anterior skull base involvement)
What is the definitive care of fractures?
–ORIF with titanium miniplates
•Soft tissue management
•Maintainance of bony dimensions – reconstruction plates or external fixators
•Free vascularised bone or soft tissue grafts
What's the operative management of panfacial trauma?
•Restore the airway
–tracheostomy or submandibular intubation
•Expose all fracture sites by planned incisions
–coronal, lower eyelid, intraoral and existing lacerations
•Connect the incisions and lacerations
– subperiosteal tunneling to facilitate direct visualisation of all operative sites
Reconstruct the load bearing structures starting from the stable posterior area and proceeding along the the zygomatic arch to the zygomatic complex.
Reconstruct facial width by fixation of the zygomas to the stable part of the upper facial third.
How can you restore the posterior vertical height?
•Reposition the and fix the condylar ramus fractures
•Restore the occlusion with intraoperative IMF
•Repositon and stabilise mandibular fractures
•ABC is vital in all trauma cases (obtain a definitive airway)
•Debridement and dressings, soft tissue management
•Analgesia - remember physical methods
•Mandibular trauma can usually wait for definitive treatment but many simple measures to reduce morbidity.
Restoration of bony dimension.
How can you deal with a low maxillary fracture?
•Gently reposition the maxilla to the position indicated by the mandible via IMF