Short Presentation

2. MANDIBULAR FRACTURE
AND ITS MANAGEMENT
DR. SAROSH HUSSAIN
OMFS DEPARTMENT

3. INTRODUCTION
 Cracking or breaking in the continuity of bone.
 Mandibular fracture is that when fracture is involved in the mandible.

4. ETIOLOGY OF MANDIBULAR
FRACTURE
 Road traffic accident (RTA).
 Interpersonal violence.
 Fall.
 Sports.
 Pathological.
 Iatrogenic.

5. SIGN AND SYMPTOMS
 Pain.
 Malocclusion.
 Swelling .
 Tenderness.
 Ecchymosis.
 Fracture of tooth/teeth.
 Laceration.
 Bone Exposure.
 Infection.
 Impaired speech.

6. INVESTIGATION
1) X-ray
Panoramic view
AP view
Town’s view
Occlusal view
Lateral oblique view
2) CT scan
3) MRI

7. CLASSIFICATION
1) On the basis of fracture site
>Condyle
>Angle
>Body
>Symphyseal
>Coronoid
>Ramus
>Alveolar

8. CLASSIFICATION
2) On the basis extend
>Green Stick are those involving incomplete fracture(no mobility).
>Simple fracture are those involving complete transection of bone.
>Comminuted fractured bone is left in multiple segment.
>Compound Exposure of bone or communication of fracture with external environment.

9. CLASSIFICATION
3) According to stability
>Favourable in a favourable fracture the fracture line and The muscle pull resist displacement
of the fracture.
>Unfavourable the muscle pull results in displacement of fracture segment.

10. MANAGEMENT
Basic principles
1) Access
2) Debridement
3) Reduction (Open/close)
4) Fixation (Internal/external)
5) Immobilisation
6) Functional Rehabilitation

11. REDUCTION
 It is a surgical / non surgical procedure to repair a fracture or dislocation to correct
alignment of bone.
Types
1)Open reduction:
when the fracture fragment ore exposed surgically by dissecting the tissues.
2)Close reduction:
It is the manipulation of bone fragments with out surgical exposure of fragments.

12. INDICATION OF CLOSE REDUCTION
 Grossly comminute
 Atrophic edentulous mandible
 Lack of soft tissue envelop
 In children
Advantage
Simplicity
Low cost
Chair side procedure

13. INDICATION OF OPEN REDUCTION
 Involve exposure of fracture through skin or mucosa
fracture are directly fixed internally.
Advantage
Reduce callus
Short healing time

14. FIXATION
Internal fixation:
1)Rigid :
Done by
Adaptational > Bicortical screws and plates
Compression > Lag screws and plates
2)Non rigid:
Circummandibular wiring
Transosseous wiring
Intramedullary pins
Suspension wiring.

15. FIXATION
External fixation:
Done by
Halo frames
External Bone pins

16. INTER MAXILLARY FIXATION (IMF)
A form of immobilization which stabilizes
bone fragments in blind manor (non
precise anatomical location) and prolong
secondary healing with large callus
formation.
1) Eyelet wiring
2) Arch bar
3) Gunning splint
4) Cast-cap silver splint

17. INTER MAXILLARY FIXATION (IMF)
Duration
Average 6 weeks
Children under 15 year > 2 weeks
Adult > 3-4 weeks
Edentulous mandible even longer
Contraindication
Uncontrolled epilepsy
Chronic obstructive disease
Combination with maxillary fracture

18. POST OPERATIVE CARE
 Monitor vital signs.
 Soft diet and good oral hygiene.
 Analgesics , Antibiotics.
 Post reduction X-ray

19. GOAL OF TREATMENT OF
MANDIBULAR FRACTURE
 Pain free mouth opening
 Good movement of jaws
 Stable TMJ
 Good facial symmetry

20. MANAGEMENT OF EDENTULOUS
MANDIBLE
Special care due to,
• Compromised blood supply
• Low cancellous bone
• Less height of bone
Treatment:-
• Ideal open reduction and internal fixation
• If possible two plate should be applied supraperiostally near lower body
• Splinting >External bone fixation
• If non-union of bone > consider bone graft

21. COMPLICATION OF MANDIBULAR
FRACTURE
1) Pre operative
 Risk to air way.
 Bleeding.
 Displacement of fracture fragment into soft tissue and
aspiration.
2) Intra operative
 Nerve damage.
 Inadequate fracture reduction.
 Access difficulty.

22. COMPLICATION OF MANDIBULAR
FRACTURE
3) Post operative
 Infection.
 Delayed healing.
 Malocclusion.
 Lip numbness.
 Non-union of teeth.
 Trismus.
 Cosmetic problems.
 Non-vital teeth.