Mandible #2 /certified fixed orthodontic courses by Indian dental academy

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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
0091-9248678078

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Mandible #2 /certified fixed orthodontic courses by Indian dental academy

  1. 1. UC Irvine Otolaryngology-Head & Neck Surgery INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  2. 2. Case Presentation  You are called to assess a patient in the trauma bay s/p fall from motorcycle onto his face. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  3. 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. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  4. 4. Additional Concerns?  Intoxication? Head Injury?  C-spine  “Open” fracture  Missing teeth? WHERE ARE THEY? www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  5. 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. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  6. 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? www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  7. 7. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  8. 8. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  9. 9. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  10. 10. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  11. 11. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  12. 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 www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  13. 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) www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  14. 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 www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  15. 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. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  16. 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. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  17. 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? www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  18. 18. Know Champy Lines www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  19. 19. Fracture Types  Condylar / Subcondylar  Ramus  Angle  Body  Parasymphaseal  Symphaseal  Alveolar Ridge www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  20. 20. Type and Management Symphaseal 2.0 L Compression + TB www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck Lag Screws
  21. 21. Type and Management Comminuted Symphaseal Left Subcondylar 2.4 Locking Recon Plate + TB www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  22. 22. Type and Management Parasymphaseal Two Miniplates? www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  23. 23. Type and Management Comminuted Parasymphaseal 2.4 Locking Recon Plate with TB www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  24. 24. Type and Management Comminuted Body/Parasymph 2.4 Locking Recon Plate with MPs www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  25. 25. Type and Management Disloc Angle w/ Basal Triangle 2.4 Locking Recon Plate with 2.0 MP www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  26. 26. Special Case Edentulous Body Fracture 2.4 Locking Recon Plate, 4 screws www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  27. 27. Another Special Case Infected Angle Fracture 2.4 Locking Recon Plate www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  28. 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. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  29. 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 www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  30. 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?) www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  31. 31. Back to Our Patient www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  32. 32. Back to Our Patient  Comminuted  High Symphaseal right subcondylar fracture/dislocation  Non-displaced left subcondylar fracture www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  33. 33. www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  34. 34. No Mas! www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck
  35. 35. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com U.C. Irvine - Otolaryngology-Head & Neck

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