Maxillomandibular fracture

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Present by: Bushara PING
Dental student in year 6th ( Faculty of Odontostomatology Phnom Penh)

Published in: Education, Health & Medicine

Maxillomandibular fracture

  1. 1. Mandibular Fracture ( part I )<br />Bushara PING, student in year 6th,, faculty of dentistry Phnom Penh<br />
  2. 2. Classification by type of fracture<br />Simple FX<br />Green stick Fx<br />Commuted <br />Class1<br />Class2 <br />Class3 in a edentilous<br />
  3. 3. Mandibular Force <br />
  4. 4. Etiology<br /><ul><li>Fracture with trauma: accident, work, fighting……
  5. 5. Fracture pathologic: infection, tumor, osseoradionecrosis.
  6. 6. bone disease: ossteoporosis, osteomalacia*,Rickets*,intoxication ( with mercure, phosphore..)</li></ul>osteomalacia*: soften of the bone typically through a deficiency of Vitamin D or Calcium.<br />Rickets* ( rachitis) : Vit D deficiency in childrend.<br />
  7. 7. Etiology<br /><ul><li>Anatomic conditions: impacted teeth, the region with lower resistence, edentilous patient with atrophy of the mandibular.</li></li></ul><li>Etiology<br />Anatomical codition<br />Fracture pathologic<br />
  8. 8. Occlusion Examination<br />Posterior contact & anterior open bite > bilateral Condylar or angle Fx<br />Posterior open bite is common with the FxParasyphysia<br />Unilateral open bite > Fxparasymphysia or angle Fx ( one side)<br />Retrognathic Occlusion > Fx angle or condylar<br />Open bite on opposite site and deviation of the chin to the Fx side > Fxcondylar neck<br />
  9. 9. Mandibular Force <br />
  10. 10.
  11. 11. Mal occlusion<br />
  12. 12. Fx partial parasymphysia with Fxalveolo-dentairkhmer soviet hospital<br />
  13. 13. How to fix the fracture?<br />Maxilomandibular Fixation ( MMF): fix for 30 to 40 day. But can’t used with the open fracture. ( using ache base and wire)<br />(Open reduction) Non-rigid fixation:using wire punch the bone and fix.<br />(Open reduction) Rigid fixation: using Plate.<br />External pin fixation:<br />Lag scrow, DCP<br />
  14. 14. MMF<br />
  15. 15. MMF<br />
  16. 16. MMF<br />
  17. 17. Ivy Loop faxation<br />
  18. 18. Non-Rigid fixation<br />
  19. 19. Non rigid fixation ( wire opacity in radiography)<br />
  20. 20. Intubation technic<br />
  21. 21. Rigid fixation ( ORIF)<br />ORIF*= Open Reduction and Internal Fixation<br />
  22. 22. Titanium plate using in rigid fixation<br />
  23. 23. External Pin Fixation<br />
  24. 24. Lag screw, DCP<br />
  25. 25. General principle for treatment<br />Tetanus<br />Nutrition<br />Almost Fx can be open fracture > Reduction and Fixation<br />Postoperative monitor<br />Oral care H2O2, irrigation, soft tootbrush<br />Two weekly chack.<br />
  26. 26. Reference<br />Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)<br />Maladies des parties molles de la cavitébuccale, Dr Keam Born<br />Master Dentistry Vol 1: oral and maxillofacial surgery, Radiology, Pathology and Oral Medicine ( Paul Coulthard, Keith Horner, Philip Lloan, ElizabthTheaker)<br />Oral Surgery: Fragiskos D. Fragiskos ( Springer-Verlag Berlin Heidelberg 2007)<br />
  27. 27. Next Session?<br />Complication post-operation.<br />Tooth luxation.<br />Fxmandibular in Children, how to menage the eruption of Permanent tooth.<br />Fixation in edentulous patient<br />
  28. 28. Thank you for you attention<br />
  29. 29. Facture Mandibular part II<br />Injury to the tooth <br />Extraction if the root fracture.<br />Classification of tooth luxation:<br />Concussion: without displacement > periodontium trauma<br />Subluxation: displacement> periodontium trauma<br />Luxation: could be extrusive, intrusive or lateral direction displacement.<br />Avulsion: completely displacement.<br />Best chance of saving tooth is re-implanted in under 1 hrs since avulsion ( master dentistry table 8 page 124)<br />Example of dental injuries<br />
  30. 30. Special consideration in pediatric<br /><ul><li>Deciduous tooth and Permanent tooth</li></ul>could be treat with MMF for 2 or 3 weeks. ( if Rigid fixation can harm to Permanent bud)<br />It is header to place wire to ach base, because of the crown is close to gingival margin.<br />NOTE: remember that mandibular fracture of child can due to Ankylosing TMJ > facial deformation, So prevent with weekly mobilisation. <br />
  31. 31. Reference: Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)<br />
  32. 32.
  33. 33. Special consideration edentulous patient<br /> Splint <br />Denture ( patient have denture)<br /><ul><li>Circumandibular and Cirumzygomatic fixation</li></li></ul><li>How to create splint fixation?<br />
  34. 34. Splint fabrication<br />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 circumandibularand circumzygomatic fixation. <br />
  35. 35. Splint fibracation<br />
  36. 36. Diagram illustration <br />
  37. 37. Ooy!!!!!!<br />Ooy!!!!<br />
  38. 38. Fixing with Denture prepatation<br />Edentulous patients may undergo closed reduction by wiring the patient's dentures to his jaws using circumandibular and circumzygomatic wires.<br />
  39. 39. Complication<br />Socioeconomic condition greatly affects<br />outcome<br />• Infection - In a prospective study by James<br />of 422 fx -infection rate was 7% of which<br />50 % were associate with fx or carious<br />teeth, of the 177 fx requiring ORIF, 12 %<br />became infected<br />
  40. 40. Complication<br />Delayed healing(3%) and nonunion(1%)<br /> – most common cause in infection<br /> – second most common cause is noncompliance<br /> – inadequate reduction, metabolic or nutritional<br /> deficiency can play a role<br /> Nerve paresthesia’s (Inf. Alveolar nerve) occur in<br />2%<br /> Malocclusion<br />TMJ problems<br />
  41. 41. Unilateral open bite<br />
  42. 42.
  43. 43. First Aid<br />Adult<br />Childrend<br />
  44. 44. Reference<br />Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)<br />Maladies des parties molles de la cavitébuccale, Dr Keam Born<br />Master Dentistry Vol 1: oral and maxillofacial surgery, Radiology, Pathology and Oral Medicine ( Paul Coulthard, Keith Horner, Philip Lloan, ElizabthTheaker)<br />Oral Surgery: Fragiskos D. Fragiskos ( Springer-Verlag Berlin Heidelberg 2007)<br />Education Program: Trauma life support Training Phnom Penh 8-13/10/2010 Bernard M. Jaffe, M.D Professor of surgery Tulane University<br />
  45. 45. Download Link:<br />http://www.4shared.com/file/lzJa0ysg/Mandibular_Fracture.html<br />
  46. 46. Thank you for attention<br />

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