Mandibular fractures / oral surgery courses

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Mandibular fractures / oral surgery courses

  1. 1. Mandibular Fractures www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. FRACTURE FRACTURE IS DEFINED AS A SUDDEN, VIOLENT SOLUTION OF CONTINUITY OF BONE AND MAY BE COMPLETE OR INCOMPLETE IN CHARACTER. FRACTURE MAY BE FROM: 1. Direct violence 2. Indirect violence 3. Excessive muscular contraction. www.indiandentalacademy.com
  4. 4. Mandibular fractures Etiology of mandibular fractures. R.T.A.------------------------------- 43% Assaults-------------------------------34% Work related------------------------ 7% As a result of fall------------------- 7% Sporting accidents------------------ 4% www.indiandentalacademy.com
  5. 5. Incidence of www.indiandentalacademy.com fracture at different site.
  6. 6. Classification According to Dorland’s medical dictionary Simple Compound Comminuted Greenstick Pathologic Multiple Impacted Atrophic Indirect Complex www.indiandentalacademy.com
  7. 7. Based on the anatomic region by Dingman and Natvig Midline Parasymphysis Body Angle Ramus Coronoid Process Condylar Process Dentoalveolar segment Based on the presence or absence of teeth- Kazanjian and Converse. Class I - Teeth present on either side of fracture fragment Class II- Teeth present on only one side of fracture fragment Class III- The patient is edentulous. www.indiandentalacademy.com
  8. 8. Horizontally Favourable Vertically Favourable Horizontally Unfavourable www.indiandentalacademy.com Vertically Unfavourable
  9. 9. Horizontally Favourable Vertically Favourable Horizontally Unfavourable www.indiandentalacademy.com Vertically Unfavourable
  10. 10. Favourable and Unfavourable Fractures of mandible www.indiandentalacademy.com
  11. 11. Clinical features Change in occlusion Anesthesia, paresthesia or dysesthesia. Abnormal mandibular movements Change in facial contour and mandibular arch form Laceration, Hematoma and Echymosis Loose teeth and crepitation on palpation Dolor, Tumor, Ruber and Color www.indiandentalacademy.com
  12. 12. Radiographic Examination Panoramic view Lateral oblique view Posterioanterior view Occlusal view Periapical view Reverse Towne’s view Temperomandibular view Computed tomography www.indiandentalacademy.com
  13. 13. MANAGEMENT • CLOSED REDUCTION • IMF- arch bars - dental wiring (direct, eyelet, multiple loop, risdon’s wiring) - cap splints in children - gunning splint - Bonded Brackets • OPEN REDUCTION - RIGID INTERNAL FIXAITON DCP, EDCP, lag screws, ASIF plates - SEMI RIGID FIXATION transosseous wiring, Champey’s mini-plates www.indiandentalacademy.com
  14. 14. Indications of closed reduction Nondisplaced favorable fractures Grossly comminuted fractures Fractures exposed with significant loss of overlying soft tissues Edentulous mandibular fractures Mandibular fractures in children Coronoid process fracture Condylar fracture www.indiandentalacademy.com
  15. 15. Choice of Method 1. Fracture pattern 2. Skill of the operator 3. Resources Available 4. General medical condition of the patient 5. Presence of other injuries 6. Degree of local contamination and infection 7. Associated soft tissue injury www.indiandentalacademy.com
  16. 16. Closed reduction and indirect skeletal fixation- different methods Direct interdental wiring (Gilmer) Indirect interdental wiring (eylet or Ivy loop) Continuous or multiple loop wiring Arch bars Cap splints Gunning type splints Pin fixation www.indiandentalacademy.com
  17. 17. Direct dental wiring (Gilmer wiring) www.indiandentalacademy.com
  18. 18. www.indiandentalacademy.com
  19. 19. Eye let wiring (Ivy loop) www.indiandentalacademy.com
  20. 20. Clove Hitch www.indiandentalacademy.com
  21. 21. Risdon’s wiring www.indiandentalacademy.com
  22. 22. Different types of Arch bars www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. Circummandibular wiring 1 2. 3. 4. 5. 6. 7. www.indiandentalacademy.com
  25. 25. www.indiandentalacademy.com
  26. 26. Indications for Open reduction Displaced unfavorable fracture through the angle Displaced unfavorable fracture of the body Multiple fractures of the facial bones Multiple # and Displaced Bilateral condylar # Fracture of an edentulous mandible with severe displacement Edentulous maxilla opposing fractured mandible www.indiandentalacademy.com
  27. 27. Open reduction and Direct skeletal fixation- Different methods Transosseous wiring Bone plating Intermedullary pinning Lag screws Titanium mesh Circumferential straps Bone clamps and Staples www.indiandentalacademy.com
  28. 28. Transosseous wiring www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. Champy’s line of osteosynthesis www.indiandentalacademy.com
  31. 31. www.indiandentalacademy.com External Pin Fixation (Ext. Fixator)
  32. 32. www.indiandentalacademy.com
  33. 33. www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com
  35. 35. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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