fracture of the angle of the mandible for postgraduate students

3. Angle fracture:
Signs and symptoms:
-Pain – Tenderness- Swelling.
-Restriction of movement.
-Muscle spasms.
-Mandibular deviation or open bite.
-Malocclusion.
-Facial asymmetry.
-Numbness.
Diagnosis:

4. Angle fracture:
Diagnostic aids
Panoramic x-ray

5. Angle fracture:
Diagnostic aids
PA view.

6. Angle fracture:
Diagnostic aids
Lateral oblique view

7. Angle fracture:
Diagnostic aids
CT
Tooth in fracture line.
Symptoms of unapparent fracture by other views.

8. Angle fracture:
Diagnostic aids
3D CT
Lag screw
Comminuted F#
Bone loss

9. Angle fracture:
Treatment options.
1-Inter maxillary fixation [MMF].
2-MMF + upper border wiring.
3-MMF + Inter osseous wiring+ upper border wiring.
4-Lag screws.
5-Upper border plate [tension plate on external oblique ridge].
6-Upper plate +lower plate.
7-Three Dimension plate.
8-Reconstruction plate.

10. Principles for selection of the proper mean of
internal fixation.
The mean of fixation should:
1-Be perpendicular to the direction of muscular pull
[displacing] forces .
2- Resist rotation [torsion] forces.
3-Be rigid enough to resist masticatory [tension] forces
[Champy principles].

11. Angle fracture:
Guide lines for selection of proper treatment line :
masticatory [tension] forces. muscular pull [displacing] forces.
muscular pull [displacing] forces.
1-Antagonize the action of muscles pull in
both directions [horizontal-vertical].
2-Rigid enough to resist masticatory
[tension] forces “tension zone” [Champy
principles].
3- Resist rotation [torsion] forces due to the
multidirectional muscles pull.

12. Angle fracture:
Treatment options.
Inter maxillary fixation
[MMF].
-Fracture should be favorable.
Horizontal favorable
Vertical favorable

13. Closed reduction with maxillo-mandibular fixation (MMF).
Angle fracture:
-Restricted to favorable fracture

14. Angle fracture:
Treatment options.
MMF
+
upper border wiring.
Vertical favorable fracture.
Horizontal unfavorable
Vertical favorable

15. Open reduction with upper border wiring and MMF.
Angle fracture:
-Minimally invasive.
-Economic.
-Required less skill.
-Non rigid.
-Should be removed.
-Possibility of lingual nerve injury.

16. Angle fracture:
Treatment options.
MMF
+
Inter osseous wiring
+
upper border wiring.
-Unfavorable fracture.
Horizontal unfavorable
-Vertical unfavorable

17. Angle fracture:
Treatment options. Lag screws [two]
-Acessibility:
Insertion of screws to be perpendicular to the fracture line

18. Angle fracture:
Treatment options.
Lag screw
+
Upper border plate.

19. Angle fracture:
Treatment options.
Upper border plate
[tension plate on external oblique ridge].
-Vertical and horizontal favorable fracture[4 holes].
-Vertical favorable and horizontal unfavorable fracture.[6 holes or
locked].
Contra-indication:
-VUF.
-HUF + VUF.

20. Angle fracture:
Treatment options.
Upper plate
+
lower plate.
-Considered the best line of treatment.
-Used in all types of fractures.
-Plate size and rigidity depends on the direction of force.

21. Angle fracture:
Treatment options.
Three Dimension plate.

22. Open reduction with 3D plate fixation.
Angle fracture:
-It acts as double plating.
-It prevents torsion movement.
-Strut plate at the mandibular angle
region. 2.0-mm titanium three-
dimensional curved angle strut
plate. [delayed/wide fracture]

23. Angle fracture:
Treatment options.
Reconstruction plate
with
other means of fixation
-Best used in comminuted fractures.

24. Surgical approach
Angle fracture:
Extra-oral approach:
-Nowadays is not common except if the
fracture is comminuted.
-In case of non rigid fixation.[Inter-osseous
wiring].
Disadvantages:
-Esthetically unacceptable scar.
-Possibility of facial nerve
branches injury.

25. Surgical approach
Angle fracture:
Intra-oral approach:
-The popular line of treatment for upper border plating
[tension zone].
-With the aid of trocar and cannula lower border
plating made easy.