2. Classification:
It has divided into different categories according
to the preference of operator or authors generally
speaking # mand are classication according to the
following:
1.According to type of#.
2.According to site of#.
3.According to cause of#.
3. Mandibular Fracture
The mandible represent the Lower 1/3 of the face.
the mand. is a thick bone but it is still have more
incidence of # (fracture) than the middle 1/3 bones
although they are much thinner.
Most of research gives the incidence of # mand. in the
a noticed ratio between # mand & middle 1/3.
4. A) Simple#.
is a linear # with little or no displacement.
it is not connected to the outside environment.
green stick # → which is seen in children may be
considered under heading of simple#.
5. B) compound#.
#which is connected to outside environment.
for this reason any # involved the tooth bearing area
of mandible is considered to be compound#
due to the fact that it is connected to the P.D.
membrane. & ligament.
6.
7. C) Cominuted#.
which is caused by more sever trauma resulting
in sever # lines connected to each other resulting in
divided the bone into several pieces.
8. D) Pathological#.
#which is caused by presence of disease or
lesion in the bone caused by simple force.
Some time force of mastication may cause # ex. of
such type of # is osteomylatis of jaw or presence of
cyst or pathological lesion inside the bone which
weakness the mandible.
9. –According to site of#:
–Different site of mandible are liable to # & these are
in consequence:
1.Dento alveolar. #
2.Condylar & condylar neck#.
3.Angle of Mand. #.
4.Body of Mand. #.
5.Symphesis & parasymphesis region#.
6.Ramus#.
7.Coronoid#.
10.
11.
12.
13.
14. Unilateral #: ⇒ this occurs as a result of direct
force # one or more than # line could be seen on
the affected side.
Bilateral #: This a combination of direct &
indirect force # s. usually occurs in the body or
symphesis region on one side & condoylar neck,
or angle of mandible on other side.
15.
16. According to cause of#:
Also as a result of excessive muscular contraction
& this occur in cases of coronoid process &
according to direct & indirect force # mand. may be
class. into the following:
1.Unilateral #: ⇒ this occurs as a result of direct
force # one or more than # line could be seen on the
affected side._
2.Bilateral #: This a combination of direct &
indirect force # s. usually occurs in the body or
symphesis region on one side & condoylar neck, or
angle of mandible on other side.
17. 3.multiple#:
this # in which we have # of symphesis region with bilateral
# lines on both sides of mand. involving condylar
or condylar neck.
or angle of mand.
4.comminuted #: ⇒this # in which may be cause by
high velocity messile or sharpness which part of mand may be
lost with part of soft. tissue overlying it is also lost & the
# presented with multiple # lines.
18.
19. Surgical anatomy
Muscular attachment Generally speaking any #
with out tearing of periostum will not result in
displacement of # line as a result of muscle action.
displace of fragment only result when there is
tearing in periostum & this is a fact.
20. In order to under stand the action of Ms. in diff.
part of mand.
we have to differentiate diff. sites:
Angle of mandible ⇒ The angle of mand
controlled by 2 thick ms. i.e
the medial ptrygoid m. & masseter m. & they act
as muscular sling arround angle of mand. med. ptry.
ms has stronger ms. pull than the masseter m.
21. according to the displacement the # line are class.
or divided into:-
A.favourable # line.
B.infavourable # line.
22. Symphesis Region:
this region is controlled by mylohyoid & genohyoid
m.
1.The # line in the middle of symph. region or in the
mand. result in stable # as a result of stabilization of ms. Pull.
2.In oblique # in this region result in inward
displacement.
3.Bilateral # of symph. region in unconscious pat. may
result in backward displace of symph. region as a result of
genioglossus ms.,
23. Condyle: the condyle is affected by lateral ptry. ms.
& this is may result in medial or inward displace of the
condyle.
Fracture of the ramus is usually sandwitched
between musseter & med. pte. ms. & the make the
possibility of displacement of # is less liable.
24. Edentulous pat. : ⇒ as a result of teeth extraction
or is resorption of alveolar bone & for this reason the
mylohyoid m. will be relatively speaking higher in
position than when the teeth are present.
this may weaken the jaw a trauma applied to the mand.
usually cause bilateral # of symph & parasymph region
with outward & downward displace.
25. Clinical presentation:
1.Bleeding will result & come out the ear this is v.
important & you must make sure that bleeding from
skin & external auditory meatus & not from middle
auditory meatus as # of base of skull with auto
cerebro-spinal-fluid (CSF) leakage.
2. #the blood may tracked itself between mastoid
bone & post. part of ramus resulting in heamatoma
formation at the back or below the ear, the should be
again distinguished from # in base of skull which have
the same clinical presentation & called (battle sign(.
3.on the unaffected side you feel movement of
condoylar, where as in the affected side the mov. may
be missing or not as noticible as of unaff.
26.
27. 4.Deviation of midline.
5.Gaging of post.–teeth on the epsilateral
teeth or side open bite on contralatrtal.
6.There is pain & limitation in jaw movement &
tender to palpation with cripitation sound in certain
cases may be heared or felled.
28.
29. Treatment of # mandible.
Emergency treatment:
deals with breathing problem & bleeding problem,
which is similar to the life saving measure disscused
in middle 1/3#.
Definet treatment: The principle of treatment of any
# of any bone is as follows:
Reduction
Fixation
Immobilization
30. 1-Reduction:
is to reduce space between 2 fragment of #s & we
have 2 types of reduction either open reduction
close reduction.
2.Fixation:
Acheif by using one of the following methods:
By using the tooth as means of fix or direct fix on
bone several methods & instrument are used for
this method either by wiring & this include direct
wiring or by using eyelit wiring.
31.
32. Direct wiring by bone:
by wiring & this include direct wiring
or by using eyelit wiring.
Using of arch bar: We have diff.
types of arch bars the most famous AB. is the
Jelenko AB. & Erich which is more flexible AB &
we apply the wire on upper & lower & tie it
together.
33.
34. By use miniplate osteosynthesis.
For Immobilization:
We use I.M.F. in which the mandible connect to the
maxilla teeth by tie wire.
