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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

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condyle

  1. 1. MAXILLOFACIAL INJURIES MANAGEMENT Primary management (ABCDE) Neurological assessment (GCS) Control of pain analgesics Control of infection antibiotics Surgical planning www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental academy www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management - immediate - definitive • Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  4. 4. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy Curved bone Thickness of cortices Neurovascular bundle Dentition Attachment of Muscles GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  5. 5. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy Areas of weakness •teeth •foramen •alveolar bone •angle •ramus •Condyle GK / MAXFAC SDM DHARWAD Blood supply Nerve supply www.indiandentalacademy.com
  6. 6. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES •Applied surgical anatomy •Classification •Clinical features •Radiological features •Management - immediate - definitive •Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  7. 7. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Anatomical site •symphysis •parasymphysis •body •angle •ramus •condyle •coronoidwww.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  8. 8. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Relation to site of injury -Direct -Indirect www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  9. 9. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Condition of fractured fragments Green Stick Simple Compound Comminuted www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  10. 10. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification: type of displacement (angle) Angle of mandible Extra oral:Gonion Intraoral: Junction of alveolar bone and ramus Fracture of angle mandible Greater fragment :teeth bearing segment Lesser fragment: ramus GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  11. 11. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Angle # Displacement of Ramus (post edentulous fragment) Favorable: Minimal displacement Unfavorable: Gross displacement Viewed from side: Horizontal Viewed from www.indiandentalacademy.com above: Vertical GK / MAXFAC SDM DHARWAD
  12. 12. Horizontally Favourable Unfavourable www.indiandentalacademy.com
  13. 13. Vertically Favourable Unfavourable www.indiandentalacademy.com
  14. 14. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification # with reference to dentition Dentulous Child Adult Edentulous Dentulous jaw with a posterior edentulous fragment www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  15. 15. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy Classification Clinical features Radiological features Management immediate definitive Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  16. 16. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Clinical Features Inspection Hemorrhage Pain Swelling Altered occlusion Sublingual ecchymosis Halitosis Paraesthesia www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  17. 17. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Clinical Features Palpation Confirm inspectory findings Tenderness Fracture line/step Crepitation Paraesthesia Abnormal mobility www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  18. 18. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy Classification Clinical features Radiological features Management immediate definitive Complications GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  19. 19. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Radiographic features OPG / Lateral oblique P A mandible Intra oral occlusal view Confirms Site and severity of # Direction & displacement of # Condition of teeth in line of # Presence of bony pathology www.indiandentalacademy.com ( 2 radiographs @ 90 deg ) GK / MAXFAC SDM DHARWAD
  20. 20. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy Classification Clinical features Radiological features Management immediate definitive Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  21. 21. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Objectives RESTORE FORM & FUNCTION Remember A B C D E Precise diagnosis Early reduction Adequate fixation and immobilization Rehabilitation / restoration of function www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  22. 22. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Immediate (Primary) ABCDE Temp immobilization Analgesics Antibiotics Diet & OHI www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  23. 23. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Definitive Reduction Fixation Immobilization Rehabilitation www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  24. 24. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management REDUCTION Closed Advantages No need for a G.A Can be used in comminuted # Continuity defects ( gun shot injuries) Disadvantages Accuracy of reduction ambiguous Poor fracture alignment www.indiandentalacademy.com Inadequate reduction GK / MAXFAC SDM DHARWAD
  25. 25. Mandibular fractures Closed reduction  Dental wiring  Arch bar  Cap splints  Gunning splints  Extra-oral pin fixation www.indiandentalacademy.com GK MAXFAC SDM DHARWAD
  26. 26. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management CLOSED REDUCTION AIM : Immobilization (IMF for 6 weeks) •Ivy eyelet wiring •Direct wiring GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  27. 27. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES •Ivy eyelet wiring GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  28. 28. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management CLOSED REDUCTION AIM : Immobilization (IMF) •Arch Bar Wiring •Extra oral pin fixation GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  29. 29. CAP SPLINT www.indiandentalacademy.com GK MAXFAC SDM DHARWAD
  30. 30. Gunning splint www.indiandentalacademy.com GK MAXFAC SDM DHARWAD
  31. 31. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management REDUCTION Open Exposure of fracture skin / mucosa Direct reduction and fixation - Transosseous Wiring - Plate & Screw Osteosynthesis www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  32. 32. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Plate & Screw Osteosynthesis (Titanium/Stainless steel) Compression plates Mini plates Lag Screws GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  33. 33. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Plate & Screw Osteosynthesis Stainless steel Mini plates GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  34. 34. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management REDUCTION Open Advantages Accurate reduction & fixation Alignment under direct visualization Disadvantages Need for a G.A & Hospitalization www.indiandentalacademy.com Expenses !!! GK / MAXFAC SDM DHARWAD
  35. 35. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Miniplate Osteosynthesis (Champy) Small malleable plate( 2 - 2.5 mm thickness) Trans oral approach No post op IMF www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  36. 36. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Miniplate Osteosynthesis Symphysis/Parasymphysis/body/angle Eyelets / Arch bars Temp IMF Intraoral Approach Exposure of fracture site(s) Curettage (haematoma) Reduction of Fracture Temporary Immobilization (IMF) www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  37. 37. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Miniplate Osteosynthesis Clinical applications Mini plate application & fixation Debridement & removal of IMF Recheck occlusion & Closure www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  38. 38. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  39. 39. Dynamic compression plates www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  40. 40. Lag Screw Fixation www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  41. 41. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Postoperative management Control of pain Control of infection Post op radiographs Physiotherapy Diet Regular follow up www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  42. 42. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Edentulous mandibles Simple #s Healing uncomplicated !!!! Displacement of # fragments variable Classification( Luhr et al) According to height of bone Class 1 : 16 - 20mm Class 2 : 11 - 15mm Class 3 : less than 10mm GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  43. 43. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Edentulous mandibles Treatment Methods Closed Reduction & Fixation Intra oral appliances: gunning splints Dentures trimmed & relined (stabilized with Circumferential wiring) Extra-oral pin fixation Immobilization period 4-6 weeks www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  44. 44. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Edentulous mandibles Treatment Methods Open Reduction & Fixation •Intra-osseous wiring •Mini-plate osteosynthesis Bilateral body #s ( bucket handle # ) (class 2 & 3) primary rib grafting reconstruction plate Precaution www.indiandentalacademy.com Excessive periosteal stripping GK / MAXFAC SDM DHARWAD
  45. 45. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Paediatric Considerations Growth Tooth buds Treatment Minimal immobilization Minimal intervention Cap splints Circum-mandibular wiring www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  46. 46. CIRCUMMANDIBULAR WIRING www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  47. 47. www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  48. 48. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  49. 49. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Indirect injury - Chin Direct injury - Zygoma www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  50. 50. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  51. 51. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Anatomical: Intra / extra capsular Unilateral / bilateral Radiographic 2 radiographs @ Right angle OPG, PA mandible 1) Level of # 2) Relationship to mandible www.indiandentalacademy.com 3) Relationship to glenoid fossa GK / MAXFAC SDM DHARWAD
  52. 52. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Level of # Head HEAD (Intra capsular) Neck Sub Condylar NECK SUB CONDYLAR # www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  53. 53. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Relationship to mandible Undisplaced Deviated Displaced www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  54. 54. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Relationship to glenoid fossa Undisplaced Displaced www.indiandentalacademy.com Dislocated GK / MAXFAC SDM DHARWAD
  55. 55. www.indiandentalacademy.com
  56. 56. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  57. 57. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Clinical features Pain & Tenderness Painful limitation in mouth opening Occlusal derangement Bleeding from ear www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  58. 58. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Clinical features - Unilateral # condyle Deviation to affected side Midline shift Lateral movements limited GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  59. 59. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Clinical features - Bilateral # condyle Gagging of posterior teeth Anterior open bite Lateral movements limited GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
  60. 60. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Radiographic investigations 2 radiographs @ right angles OPG, PA mandible Optional : Trans Pharyngeal Trans Cranial Trans Orbital C.T coronal views www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  61. 61. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  62. 62. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Management (Conservative) No active treatment Immobilization (7-10 days) Active physiotherapy www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  63. 63. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Management (Surgical) Open reduction & fixation Grossly dislocated #s www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  64. 64. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
  65. 65. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Complications Malocclusion Damage to teeth TMJ pain Ankylosis Open reduction Scar Nerve damage Intra-operative haemorrhage www.indiandentalacademy.com Avascular necrosis GK / MAXFAC SDM DHARWAD
  66. 66. If you cannot convince people - confuse them www.indiandentalacademy.com
  67. 67. THANK YOU For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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