Mandibular Fracture ( part I )

Bushara PING, student in year 6th,, faculty of dentistry Phnom Penh

Classification by type of fracture

• Simple FX• Green stick Fx• Commuted • Class1• Class2 • Class3 in a edentilous

Mandibular Force

Etiology

Fracture with trauma: accident, work, fighting…… Fracture pathologic: infection, tumor,

osseoradionecrosis. bone disease: ossteoporosis,

osteomalacia*,Rickets*,intoxication ( with mercure, phosphore..)

osteomalacia*: soften of the bone typically through a deficiency of Vitamin D or Calcium.

Rickets* ( rachitis) : Vit D deficiency in childrend.

Etiology

Anatomic conditions: impacted teeth, the region with lower resistence, edentilous patient with atrophy of the mandibular.

Etiology

Anatomical codition Fracture pathologic

Occlusion Examination

• Posterior contact & anterior open bite > bilateral Condylar or angle Fx

• Posterior open bite is common with the Fx Parasyphysia

• Unilateral open bite > Fx parasymphysia or angle Fx ( one side)

• Retrognathic Occlusion > Fx angle or condylar• Open bite on opposite site and deviation of the

chin to the Fx side > Fx condylar neck

Mandibular Force

Mal occlusion

Fx partial parasymphysia with Fx alveolo-dentair khmer soviet hospital

How to fix the fracture?

• Maxilomandibular Fixation ( MMF): fix for 30 to 40 day. But can’t used with the open fracture. ( using ache base and wire)

• (Open reduction) Non-rigid fixation:using wire punch the bone and fix.

• (Open reduction) Rigid fixation: using Plate.• External pin fixation:• Lag scrow, DCP

MMF

MMF

MMF

Ivy Loop faxation

Non-Rigid fixation

Non rigid fixation ( wire opacity in radiography)

Intubation technic

Rigid fixation ( ORIF)

ORIF*= Open Reduction and Internal Fixation

Titanium plate using in rigid fixation

External Pin Fixation

Lag screw, DCP

General principle for treatment

• Tetanus• Nutrition• Almost Fx can be open fracture > Reduction

and Fixation• Postoperative monitor• Oral care H2O2, irrigation, soft tootbrush• Two weekly chack.

Reference

• Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)• Maladies des parties molles de la cavité buccale, Dr Keam

Born• Master Dentistry Vol 1: oral and maxillofacial surgery,

Radiology, Pathology and Oral Medicine ( Paul Coulthard, Keith Horner, Philip Lloan, Elizabth Theaker)

• Oral Surgery: Fragiskos D. Fragiskos ( Springer-Verlag Berlin Heidelberg 2007)

Next Session?

• Complication post-operation.

• Tooth luxation.• Fx mandibular in

Children, how to menage the eruption of Permanent tooth.

• Fixation in edentulous patient

Thank you for you attention

Facture Mandibular part II• Injury to the tooth Extraction if the root fracture.• Classification of tooth luxation:Concussion: without displacement

> periodontium traumaSubluxation: displacement>

periodontium traumaLuxation: could be extrusive,

intrusive or lateral direction displacement.

Avulsion: completely displacement.Best chance of saving tooth is re-

implanted in under 1 hrs since avulsion ( master dentistry table 8 page 124)

Example of dental injuries

Special consideration in pediatric

Deciduous tooth and Permanent tooth• could be treat with MMF for 2 or 3 weeks. ( if

Rigid fixation can harm to Permanent bud)• It is header to place wire to ach base, because

of the crown is close to gingival margin.• NOTE: remember that mandibular fracture of

child can due to Ankylosing TMJ > facial deformation, So prevent with weekly mobilisation.

Reference: Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)

Special consideration edentulous patient

• Splint • Denture ( patient have denture)

• Circumandibular and Cirumzygomatic fixation

HOW TO CREATE SPLINT FIXATION?

Splint fabrication

To make the splints, an impression is first made. Next, a cast made out of plaster or stone is made from the impression. Then acrylic splints are made with holes for wiring and grooves for circumandibular and circumzygomatic fixation. 

Splint fibracation

Diagram illustration

Ooy!!!!

Ooy!!!!!!

Fixing with Denture prepatation

Edentulous patients may undergo closed reduction by wiring the patient's dentures to his jaws using circumandibular and circumzygomatic wires.

Complication

• Socioeconomic condition greatly affectsoutcome• Infection - In a prospective study by Jamesof 422 fx -infection rate was 7% of which50 % were associate with fx or cariousteeth, of the 177 fx requiring ORIF, 12 %became infected

Complication

• Delayed healing(3%) and nonunion(1%)– most common cause in infection– second most common cause is noncompliance– inadequate reduction, metabolic or nutritionaldeficiency can play a role

• Nerve paresthesia’s (Inf. Alveolar nerve) occur in2%• Malocclusion• TMJ problems

Unilateral open bite

First AidAdult

Childrend

Reference

• Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)• Maladies des parties molles de la cavité buccale, Dr Keam

Born• Master Dentistry Vol 1: oral and maxillofacial surgery,

Radiology, Pathology and Oral Medicine ( Paul Coulthard, Keith Horner, Philip Lloan, Elizabth Theaker)

• Oral Surgery: Fragiskos D. Fragiskos ( Springer-Verlag Berlin Heidelberg 2007)

• Education Program: Trauma life support Training Phnom Penh 8-13/10/2010 Bernard M. Jaffe, M.D Professor of surgery Tulane University

Download Link:

• http://www.4shared.com/file/lzJa0ysg/Mandibular_Fracture.html

Thank you for attention