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Mandibular
Fractures

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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

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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.
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Mandibular fractures
Etiology of mandibular fractures.
R.T.A.------------------------------- 43%
Assaults-------------------------------34%
Work related------------------------ 7%
As a result of fall------------------- 7%
Sporting accidents------------------ 4%
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Incidence of www.indiandentalacademy.com
fracture at different site.
Classification
According to Dorland’s medical dictionary
Simple

Compound

Comminuted

Greenstick

Pathologic

Multiple

Impacted

Atrophic

Indirect

Complex
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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.
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Horizontally Favourable

Vertically Favourable

Horizontally Unfavourable

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Vertically Unfavourable
Horizontally Favourable

Vertically Favourable

Horizontally Unfavourable

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Vertically Unfavourable
Favourable and Unfavourable Fractures of mandible

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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
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Radiographic Examination
Panoramic view

Lateral oblique view

Posterioanterior view

Occlusal view

Periapical view

Reverse Towne’s view

Temperomandibular view
Computed tomography
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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

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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
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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
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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
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Direct dental wiring (Gilmer wiring)

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Eye let wiring (Ivy loop)

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Clove Hitch

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Risdon’s wiring

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Different types of Arch bars
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Circummandibular wiring

1

2.

3.
4.

5.

6.

7.
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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
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Open reduction and Direct skeletal
fixation- Different methods
Transosseous wiring
Bone plating
Intermedullary pinning
Lag screws
Titanium mesh
Circumferential straps
Bone clamps and Staples
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Transosseous wiring
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Champy’s line of osteosynthesis

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External Pin Fixation (Ext. Fixator)
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Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com

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Mandibular fractures / oral surgery courses