Mandibular fractures / fixed orthodontic courses

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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.


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Mandibular fractures / fixed orthodontic courses

  1. 1. Fractures of the mandible www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Fractures of the mandible www.indiandentalacademy.com
  4. 4. Types of fractures Simple  Compound  Comminuted  Complicated  Impacted  Greenstick  Pathological www.indiandentalacademy.com
  5. 5. Types of fractures Simple  Intact soft tissues with no communication with exterior or closed fracture E.g.Condyle, coronoid process, Edentulous mandible with intact mucoperiosteum www.indiandentalacademy.com
  6. 6. Types of fractures Compound  Communication open fracture with exterior or E.g.Fractures involving tooth bearing area of dentulous mandible www.indiandentalacademy.com
  7. 7. Types of fractures Comminuted  Shattering or fragmentation of bone E.g.Gunshot injuries, severe trauma www.indiandentalacademy.com
  8. 8. Types of fractures Complicated  Involvement of nerves, blood vessels or joints E.g.Involvement of inferior alveolar neurovascular bundle www.indiandentalacademy.com
  9. 9. Types of fractures Greenstick  Incomplete, without displacement of fragments E.g.Fracture of the neck of the condyle in children www.indiandentalacademy.com
  10. 10. Types of fractures Impacted  Driven or fragment forced into another No clinical movement E.g.Maxillary and Zygomatic complex www.indiandentalacademy.com
  11. 11. Types of fractures Pathological  Spontaneous with minimal or no trauma  Mainly due to underlying pathology E.g.Malignancy, benign tumors, cysts, osteomyelitis www.indiandentalacademy.com
  12. 12. Facial fractures Distribution:  Mandible alone - 33.7% to 67.9%  Mid face alone – 23.6% to 57.7%  Mandible and Mid face- 8.00% to 9.28% www.indiandentalacademy.com
  13. 13. Mandibular fractures Etiology:  R.T.A’s  Fights  Falls  Sport Injuries  Industrial  Others www.indiandentalacademy.com
  14. 14. Mandibular fractures Applied Anatomy Position and shape Structure Nerve and blood supply Muscle attachments www.indiandentalacademy.com
  15. 15. Mandibular fractures Classification Based on site ⇒Condyle and Coronoid ⇒Ramus and Angle ⇒Body and Symphysis ⇒Dentoalveolar www.indiandentalacademy.com
  16. 16. Mandibular fractures Classification:Kazanzian and Converse Based on presence of teeth Class-I Teeth on both fragments Class-II  Teeth on one fragment Class–III Edentulous mandible www.indiandentalacademy.com
  17. 17. Mandibular fractures Classification:Rowe and Killey   Not Involving basal bone E.g. Dento-alveolar  Involving basal bone e.g. Single unilateral Double unilateral Bilateral Multiple www.indiandentalacademy.com
  18. 18. Mandibular fractures Classification:Horizontally Favourable Vertically Unfavourable Horizontally Vertically www.indiandentalacademy.com
  19. 19. Horizontally Favourable Unfavourable www.indiandentalacademy.com
  20. 20. Vertically Favourable Unfavourable www.indiandentalacademy.com
  21. 21. Mandibular fractures Diagnosis: History Clinical examination Radiographic examination www.indiandentalacademy.com
  22. 22. Mandibular fractures Diagnosis History  Health history  Type and direction of trauma  Object of violence www.indiandentalacademy.com
  23. 23. Mandibular fractures Diagnosis Clinical features: Change in occlusion  Numb lower lip  Echymosis & hematoma  Crepitation  Pain, swelling, redness  Loss of function  Deformitywww.indiandentalacademy.com or asymmetry
  24. 24. Mandibular fractures Diagnosis Radiographs: O.P.G.  Lateral oblique views  P. A. views  T. M. J. views  Lower occlusal  I. O. P. A. www.indiandentalacademy.com
  25. 25. Mandibular fractures Management Primary care  aimed at general condition Airway Hemorrhage Shock Pain Infection Initial care of the fracture www.indiandentalacademy.com
  26. 26. Mandibular fractures Airway obstruction Blood clots, vomit, bone, teeth, denture fragments  Inhalation  Backward displacement of tongue  Downward and displacement of maxilla www.indiandentalacademy.com backward
  27. 27. Mandibular fractures Airway Maintenance Toilet of the oral cavity  Disimpaction of maxillae  Stable lateral position  Transfixation of tongue  Gudel airway  Endo tracheal intubation  Tracheostomy www.indiandentalacademy.com
  28. 28. Mandibular fractures Infection :- Prevention Tetanus prophylaxis  Antibiotics  Prophylaxis for C.S.F rhinorrhea www.indiandentalacademy.com
  29. 29. Mandibular fractures Control of pain Avoid giving powerful analgesics  Sedation with diazepam – 10 mg I-V  Pentazocine 15 to 30 mgs www.indiandentalacademy.com
  30. 30. Mandibular fractures Control of pain Disadvantage of morphine  Depresses respiration  Depresses level of consciousness  Depresses cough reflex  Constriction of pupil www.indiandentalacademy.com
  31. 31. Mandibular fractures Management:- Definitive Aimed at treating fracture itself  Reduction  Fixation  Immobilization  Rehabilitation www.indiandentalacademy.com
  32. 32. Mandibular fractures Reduction: Types  Closed reduction a. Manipulation b.Traction Open reduction www.indiandentalacademy.com
  33. 33. Mandibular fractures Closed reduction Indications ⇒Favorable fractures ⇒Comminuted fractures ⇒Edentulous fractures ⇒In children ⇒Coronoid process www.indiandentalacademy.com
  34. 34. Mandibular fractures Management:Methods of fixation used with closed reduction  Dental wiring  Arch bar  Cap splints  Gunning splints  Extra-oral pin fixation www.indiandentalacademy.com
  35. 35. Gunning splint Cap splint www.indiandentalacademy.com
  36. 36. Mandibular fractures Open reduction Indications  Unfavorable fracture at angle of the mandible  Severely displaced fractures  Bilateral condyle midface fractures fractures  Where treatment is delayed  Non-united fractures www.indiandentalacademy.com  Rigid fixation to be used with
  37. 37. Mandibular fractures Management:Methods of fixation used with open reduction  Trans osseous wiring  Compression plates  Non compression plates  Lag screws www.indiandentalacademy.com
  38. 38. Mandibular fractures Compression Plates  Advantages: Anatomic reduction  Fracture fragments compression  Rigid immobilization www.indiandentalacademy.com
  39. 39. www.indiandentalacademy.com
  40. 40. www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42. Alveolar fractures Immobilization Methods Cold curing acrylic splint  Composite resin splint  Arch bar  Figure of eight wiring  Loop wiring  Metal splint www.indiandentalacademy.com
  43. 43. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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