This document discusses the management of mandible fractures. It begins with a case presentation of a patient involved in a motorcycle accident and presents exam findings of a degloving chin laceration communicating with the oral cavity and dental malocclusion. It then reviews considerations for additional injuries, imaging studies, immediate management including antibiotics and pain control, and concepts for fracture reduction and fixation techniques using various plate types.

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2. Case Presentation
 You
are called to assess a patient in the
trauma bay s/p fall from motorcycle onto
his face.
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3. Exam Findings
 ABC
– talking, slurred speech,
hemodynamically stable.
 Extensive degloving chin laceration
communicates with oral cavity. Some
dental step-off, obvious malocclusion.
 No neck swelling or soft tissue injury.
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4. Additional Concerns?
 Intoxication?
Head Injury?
 C-spine
 “Open”
fracture
 Missing
teeth? WHERE ARE THEY?
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5. Rest of Exam
 PERRL/EOMi,
no raccoon eyes
 Midface Stable, no septal hematoma, no
step-offs in midface
 Fresh blood occluding EACs bilaterally
 Malocclusion, 1.5 cm MICD due to pain
 Ecchymosis under tongue with minimal
retrodisplacement. FOL – airway clear.
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6. Studies Done
 CT
Head w/o contrast (very limited view)
 CT Face Axial/Coronal w/ 3-d recons
 Prefer
preoperative mandible series with
panorex…why?
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12. Mandible Fracture
 Very
often more than one fracture present
 May
result in airway compromise (acute or
delayed)
 Elevated
 Almost
risk of c-spine injury
always considered contaminated
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13. Immediate Management
 Rule
out other significant injury including
brain and c-spine
 Monitor for airway issues – repeat exam
(may include FOL), monitored bed
 Start antibiotics immediately (what type?)
 Pain management
 Document CN function (esp inf alveolar)
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14. Considerations In Mandible Fx
 Much
of the morbidity of these injuries is
attributed to improper management.
 Infection risk increases with passage of
time, substantially higher after 72h.
 Risks of nonunion, malunion, malocclusion,
plate fracture, plate extrusion, TMJ fixation,
jaw restriction, poor cosmetic outcome
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15. Steps to Avoid Problems
 Proper
diagnosis
 Consider Co-morbid Conditions
 Consider Patient Personality/Occupation
 Proper management plan for the
circumstances
 Proper technique (MMF, bending, drilling,
screw placement, nerves, tooth roots)
 When in doubt, use a LARGER plate.
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16. Concepts in Reduction
 Patient’s
baseline occlusion is first priority.
 Class I, II, III … Crossbite?
 Observe wear facets
 Do not force class I if it doesn’t line up with
wear facets.
 Verify occlusion at beginning, mid, end of
case. Remove MMF to verify if necessary.
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17. Plate Types
 What
is…
– A tension band?
– A compression plate?
– A lag screw?
– A recon (UF) plate?
– A locking plate?
– Load sharing vs. load bearing plate?
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18. Know Champy Lines
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19. Fracture Types
 Condylar
/ Subcondylar
 Ramus
 Angle
 Body
 Parasymphaseal
 Symphaseal
 Alveolar
Ridge
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20. Type and Management
Symphaseal
2.0 L Compression + TB
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Lag Screws

21. Type and Management
Comminuted Symphaseal
Left Subcondylar
2.4 Locking Recon Plate + TB
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22. Type and Management
Parasymphaseal
Two Miniplates?
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23. Type and Management
Comminuted Parasymphaseal
2.4 Locking Recon Plate with TB
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24. Type and Management
Comminuted Body/Parasymph
2.4 Locking Recon Plate with MPs
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25. Type and Management
Disloc Angle w/ Basal Triangle
2.4 Locking Recon Plate with 2.0 MP
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26. Special Case
Edentulous Body Fracture
2.4 Locking Recon Plate, 4 screws
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27. Another Special Case
Infected Angle Fracture
2.4 Locking Recon Plate
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28. Other Special Cases
 Bilateral
Parasymphaseal – Geniohyoid origin
lost, tongue prolapses into airway.
 Bilateral
subcondylar – prone to TMD, loss of
height, retrusion and increased width of mandible.
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29. Type and Management
Pediatric Fractures – remove plates or use
absorbable, minimize MMF.
Loss of Bone – from infection, severe trauma or
nonunion.
Symphaseal and Angle, 3rd Molar
Single Champy MP at Angle
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30. Controversies/Difficulties
 When
to perform ORIF on subcondylar
 Tooth in the fracture line
 Stops for unilateral subcondylar
 Missing Teeth (but not edentulous)
 When to go extra-oral route
 How long to continue abx postop (Ali?)
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31. Back to Our Patient
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32. Back to Our Patient
 Comminuted
 High
Symphaseal
right subcondylar fracture/dislocation
 Non-displaced
left subcondylar fracture
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34. No Mas!
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35. Thank you
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