Dentist in pune. (BDS. MDS) - Dr. Amit T. Suryawanshi. Seminar-Canine Impaction.
Email ID- amitsuryawanshi999@gmail.com
Contact -Ph no.-9405622455
Subscribe our channel on youtube - https://www.youtube.com/channel/UC_gylEXTrjmEbbOTSXjuZ4Q/videos?view_as=public
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A Brief description of the causes and clinical manifestations of the internal derangement of the temporomandibular joint , with particular emphasis on Disc Displacements .
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
A Brief description of the causes and clinical manifestations of the internal derangement of the temporomandibular joint , with particular emphasis on Disc Displacements .
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
The lower jaw frequently breaks due to accidents, assaults or sometimes due to underlying disease. Just as with other bones in the body, there are a various methods for repairing the mandible.
The lower jaw frequently breaks due to accidents, assaults or sometimes due to underlying disease. Just as with other bones in the body, there are a various methods for repairing the mandible.
Pattern of Pediatric Mandibular Fracture in Central Indiaiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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Dentist in pune.(BDS. MDS) - Dr. Amit T. Suryawanshi. Mandibular angel fracturesAll Good Things
Dentist in pune. (BDS. MDS) - Dr. Amit T. Suryawanshi. Seminar-Canine Impaction.
Email ID- amitsuryawanshi999@gmail.com
Contact -Ph no.-9405622455
Subscribe our channel on youtube - https://www.youtube.com/channel/UC_gylEXTrjmEbbOTSXjuZ4Q/videos?view_as=public
Follow us on slideshare
Dr Rahul VC Tiwari - Oral & Maxillofacial Surgery - SIBAR Institute of Dental Sciences, Gunutr, Andhra Pradesh. A Detailed Analysis of Mandibular Angle Fractures: Epidemiology,
Patterns, Treatments, and Outcomes
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Condylar fractures /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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Maxillofacial trauma mandible /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Dentist in pune.(BDS) MDS- OMFS - Dr. Amit T. Suryawanshi.. Mandibular fractures- Everything about it.
1. Dr. Amit T. Suryawanshi
Dentist, Oral and Maxillofacial Surgeon
Pune, India
Contact details :
Email ID - amitsuryawanshi999@gmail.com
Mobile No - 9405622455
2. MANAGEMENT of mandibular fracture depends on
knowlege with dental anatomy, head and neck
physiology and occlusion
The mandible is the second most commonly fractured
bone in maxillofacial skeleton because of its position
of prominence.
The location and pattern of the fracture are
determined by the mechanism of injury, and the
direction of the vector of the force.
Advancement related to management- Rigid internal
fixation.
3. U – shaped body
Vertically directed
rami
Coronoid
Condyle
Oblique line
Mental foramen
5. Muscle Sling
• Vertical rami totally
embedded within sling
– Masseter
– Pterygoids
• Angle and condylar neck
not entirely protected by
sling
– Bony trabecular crests,
ridges, lines
• Trabeculae resist normal
tension, compression,
and rotation of
mastication
– Little resistance to lateral
stress from blunt trauma
7. Innervation
• Mandibular nerve through the foramen ovale
• Inferior alveolar nerve through the mandibular
foramen
• Inferior dental plexus
• Mental nerve through the mental foramen
8. Arterial supply
• Internal maxillary artery from the external carotid
• Inferior alveolar artery through the mandibular
foramen
• Mental artery through the mental foramen
9. • 1650 BC –Edwin smith surgical papyrus
• Hippocrates- cicumferential dental
• 1275 - Salicetti-IMF
• Gilmer- To apply correctly
• 20 th century –MM fixation or Gunning type splints for the
edentulous.
• 1968 - Luhr& Spiessl -idea of using miniature bone plates
10. 1976 – Spissel in german speaking countries
Concept-based on orthopedic principles and
trying to fit orthopedic material to the
complex and very different structure of facial
skeleton.
Absolute interfragmentory immobilization is
achieved with no resorption of fracture ends,
no callous formation, and intracortical
remodelling across the fracture site whereby
the fractured bone cortex is gradually
replaced by new Haversian systems .
“C a l l o u s f o r m a t i o n c o n s i d e r e d a failure”
11. • Plates are bulky, very large to use, and always
required large skin incision. Neck scar
undesirable
• Nerve damage –both inferior alveolar and Facial
• Infection of the plates
• Resurgery to remove plates always necessary.
Biomechanically in a wrong position
12. 1973- Michelet introduced a new technique,
using smaller Miniplates in intraoral
approach.
Principle- like a suspension bridge to define
tension in a fracture.
Champy et al – refined and researched
13. Bone tensile failure results from tensile
strain rather than compressive strain
Similar to arch-distributes the force of
impact throughout its length.
Foramina, sharp bends, ridges and reduced
cross sectional dimension – tensile strain
concentration
14. WIDE RANGE of magnitude and direction of
impacts
Condition of the dentition, position of the
mandible at the time of impact and influence
of associated soft tissues.
Relation with Dentition
Presence of posterior teeth - reduce condylar
fracture
Impacted third molar-area of internal
weakness
15.
16.
17. Assault
Road traffic accidents
Sports injuries
Industrial or work place accidents
Falls, which may be a trip or a medical
syncope .
18. At least two films at right angles
Standard-OPG & reverse townes
# parasymphysis-occlusal film
CT-cost sensitive
- concomitant midface fractures
- communited fractures
- condylar fractures -3D reconstruction
- cervical spine injury
- very young patients- under sedation
19. Change in occlusion
Paresthesia, anesthesia
Localized pain
Altered range of motion or deviation of the
mandible.
Changes in facial contour ,symmetry and dental
arch form
Lacerations, hematoma, sub lingual echymosis
Mobility of the tooth
Crepitus or mobility of bone segments
Palpable bony steps.
20.
21. Simple :no external contamination
Compound: communication with external environment.
Comminuted: multiple segments of bone that have been
splintered or crushed.
Green stick: one cortex is compromised ,but the other is
intact.
Pathologic: pre existing disease or lesion associated with a
fracture site.
Multiple: two or more lines of fracture on the same
bone ,but not communicating with one another.
Impacted: one segments is telescoped within the adjacent
fragment.
Atropic: decreased bony mass
Indirect: fracture is present at the site distant from the
point of impact
Complex: associated soft tissue injury
22.
23. ANATOMIC
Symphysis
Body
Angle
Ramus
Coronoid
Condylar process
Dentulous
Partially edentulous
Dentulous
Primary or mixed dentition
BIOMECHANICAL
FAVORABLE : muscle pull will tent to keep the fracture reduced.
UNFAVORABLE: muscle pull will tent to distract the segments.
27. Symphysis region, which is formed by the
bony union of 2 halves in the centre at the
first year of life.
Parasymphysis region, which lies lateral to
the mental prominence.
The angle of the mandible
The neck of the mandibular candyle.
28. G. Acc. To presence or absence of teeth in
relation to # line.
Kazanjian Classification:
Class 1: When teeth are present on both sides
of the fracture line.
Class 2 : When teeth are present only on one
side of the fracture line.
Class 3: When both fragments on each side of
fracture line are edentulous.
29. Clinical Examination:
1. Immediate assessment : Pts with
maxillar injuries may have sustained
other bodily injury which may be a
threat to life therefore they should be
considered first.
2. General Clinical Examination : # of the
mandible are caused by trauma & the
patient may also suffer from injury
elsewhere in the body.A thorough
general assessment of the patient should
be carried out.
30. 3. Local examination of the fracture
Extra oral examination:
Most of the physical signs of a fractured
bone result from the extravasation of
blood from the damaged bone ends.
Swelling and ecchymosis indicate the site of
any mandibular fracture.
There may be obvious deformity in the bony
control and if considerable displacement
has occurred, the pt’s mouth hangs
open.
31. Intraoral Examination:
The buccal and lingual sulci are examined
for ecchymosis
Occlusal plane is next examined
Individual teeth along with luxation and
subluxation are noted.
Mobility is checked of the possible fracture
sites.
Signs and symptoms of mandibular
fractures at various fracture sites:
32. 1. Dentoalveolar : Those in which avulsion,
subluxation or fracture of the teeth occur
in association with the alveolus.
2. Fracture of the coronoid process: It is
usually considered to result from reflex
contracture of the powerful ant fibres of
temporalis muscle. It is diff to diagnose
clinically. There may be tenderness over
the area, painful limitation of movement,
esp protrusion of the mandible.
33. 3.Fracture of the ramus : Swelling and
ecchymosis is seen extraorally and
intraorally. Tenderness, severe trismus is
usually present.
4.Fracture of the angle : Swelling at the angle
externally and there may be obvious
deformity. Hematoma, derangement of
occlusion. On palpation, tenderness and
crepitus is elicited, movements are painful.
5. Fracture of the body: Similar to fracture
of the angle.Even slight displacement causes
derangement of occlusion.
35. Evaluation
– Pain, malocclusion, trismus, V3 sensory
deficit
– History of TMJ (earlier mobilization)
– Blow to face favors parasymphyseal fracture
and contralateral angle fracture
– Fall to chin (bilateral condylar fractures)
37. Evaluation - History
• Mechanism of injury
_ multiple comminuted fx
– Fist often results in single, non - displaced
fx
– Anterior blow to chin - bilateral condylar fx
– Angled blow to parasymphysis can lead to
contralateral condylar or angle fx
– Clenched teeth can lead to alveolar
process fx
38. Physical Exam - Occlusion
• Change in occlusion - determine preinjury occlusion
• Posterior premature dental contact or an anterior
open bite is suggestive of bilateral condylar or angle
fractures
• Posterior open bite is common with anterior alveolar
process or parasymphyseal fractures
• Unilateral open bite is suggestive of an ipsilateral
angle and parasymphyseal fracture
• Retrognathic occlusion is seen with condylar or angle
fractures
• Condylar neck fx are assoc with open bite on
opposite side and deviation of chin towards the side
of the fx.
39. Physical Exam
• Anesthesia of the lower lip
• Abnormal mandibular movement
– unable to open - coronoid fx
– unable to close - fx of alveolus, angle or
ramus
– trismus
• Lacerations, Hematomas, Ecchymosis
• Loose teeth
• Palpation
40. Physical Exam
• Dental Exam
– Lost, fractured, or unstable teeth
– Dental Health
– Relation to fracture
– Quantity
42. Physical Exam, Cont
• Inability to open the mandible suggests impingement of the coronoid
process on the zygomatic arch
• Inability to close the mandible suggests a fracture of the alveolar
process, angle, ramus or symphysis
43. Lacerations and Ecchymosis
• Mandibular fractures can often be directly visualized beneath facial
lacerations.
• Lacerations should be closed after definitive therapy of the fracture
• Ecchymosis is diagnostic of symphyseal fractures
44. Palpation
• The mandible should be palpated with both hadns, with the thumb on
the teeth and the fingers on the lower border of the mandible. Slowly
and carefully place pressure, noting the characteristic crepitation of a
fracture
45.
46. Techniques for mandibular
fractures with closed reduction
Direct interdental wiring [Gilmer]
1.First aid method for temporary immobilization.
2.5cm of .35mm wire used.
3.ADVANTAGE: Simple technique.
4.DISADVANTAGE: A loose or broken wire cannot
be replaced without removing and replacing others
56. AAccrryyllaatteedd aarrcchhbbaarrss
SScchhuucchhaarrdd’’ss mmooddiiffiiccaattiioonn 11995566
1.Aluminium-brass alloy wire 2mm in
diameter used.
2. 6 pieces of 1.4mm wire soldered to the
main wire
3.Advantages:
a.Does not compress on gingival tissue.
b.Reduced chances of pressure necrosis and
stagnation.
c.Enhanced patient comfort.
58. Directly bonded archbars
1.Orthodontic mesh welded on to the back
of archbar.
2.Made in sections.
3.Bonded by composite or acrylic.
4.Not popular due to the difficulty in
maintaining dryness.
72. Rigid Fixation
• Compression plates
– Rigid fixation
– Allow primary bone healing
– Difficult to bend
– Operator dependent
– No need for MMF
73. Rigid Fixation
• Miniplates
– Semi-rigid fixation
– Allows primary and secondary bone healing
– Easily bendable
– More forgiving
– Short period MMF Recommended
74. Rigid Fixation
• Reconstruction Plates
– Good for comminuted fractures
– Bulky, palpable
– Difficult to bend
– Locking plates more forgiving
75. External Fixation
• Alternative form of rigid fixation
• Grossly comminuted fractures, contaminated fractures, non-union
• Often used when all else fails
77. Teeth in line of fracture
• Keep teeth if
– Previously healthy
– Peridontal plexus intact
– No major structural injury
– Tooth does not interfere with reduction of
fracture
78. Bioabsorbable Plates
• Plating can relieve stress, no bone remodeling
• Bulky plates, thermal sensitivity, palpable
• Absorbable plates expensive
• Better in children?
• Use of poly-L-lactide in 69 fractures by Kim et al
– 12% complication
– 8% infection
– No malunion
79. • Cases in which mandible appears stable
• Favorable fracture pattern
• No displacement of bony segments
• No change in occlusion
• Motivated patient
• Management
- Careful observation
- Liquid diet, limited physical activity
Remain prepared to intervene
80. Some type of external stabilization
Common-eyelet wiring, Erich arch bars, ivy
loops, stout wiring, Ernst and Gilmer
ligatures
Bonded arch bars
modified bone screws
Massive communition of mandible with
significant tissue loss-external
pin stabilization
81. Nondisplaced ,stable fractures
Grossly communited fractures-periosteal
stripping may devitalize small bone fragments
Gunshot wounds
Compromised soft tissue matrix
-Result of pre existingcondition(radiotheraphy)
-Avulsive loss of tissue
Pediatric fractures
82. Open approach gives best
visuvalization,anatomical reduction
Trans oral apporach-5to 7mm from
mucogingival junction
Percutaneous trocar
Skin incisins-reserved for condylar
neck,grossly communited factures,severly
atrophic mandible(<10mm height)
Heavy training elastics-neuromuscular
training
83.
84. Screw itself has a threaded head which
engages the plate
Plate does not have to be ideally adopted
Heavier stronger design
Elimination of bone resorption
Role in
gross communition
continuity defects prior to formal
reconstruction
85. Excellent alternative in selected cases of
anterior mandible #
Posterior mandible and ramus-technically
difficult
Trocar may necessary
86.
87. Technically difficult to repair, associated
complications are frequent.
REASONS
(1)Force is necessary to create this type of
injury carries with a higher degree of
surrounding tissue injury
(2)Increase difficulty with reduction and
stabilization of multiple fragments.
(3)High risk for ischemic
compromised fragments
to necrosis.
88. Reduced vascularity to the mandible due to the
decrease in flow from inferior alveolar artery.
Blood supply is mainly periosteal
Dense sclerotic bone and decreased osteoblastic
activity
Less bone area contact
Systemic compromise
Most edentulous fractures –at body or condyle
Mid body or saddle –weakest point
89. Closed reduction with the use of
prosthetics(existing dentures or Gunning splints.)
External fixation
Wire fixation
Open reduction with internal fixation:
1. Reconstruction plates (2.3 , 2.7 mm
diameter screws)
2. Mandible fixation plates (2.0, 2.4 mm
diameter screws)
- Dynamic compression plates
- Plates at both inferior and superior
borders
3. Bone grafting and miniplate fixation.
90.
91. MALUNION NONUNION
It is a site with high incidence of altered fracture healing .
Infection it is the main contributor.
OTHER CAUSES
-poor apposition
-poor immobilization
-presence of foreign bodies
-unfavorable muscle pull on fracture segments
-aseptic necrosis of bone fragments
-soft tissue interposition
-malnutrition by debilitation.
Most common cause for nonunion is residual mobility
across fracture.
92. Rigid internal fixation with a reconstruction
plate
External fixation
Particulate bone grafting or Cortical bone
grafting to the defect.
Polyglycolic or polylactate mesh as a carrier
for cancellous bone graft.
Composite free flap reconstruction.
93. Most common complication of surgical
interaction.
Risk factor-
-Communited fracture
-Active substances abuse.
-Noncompliance with post operative regimens.
-Significant delayed treatment
MANIFESTATIONS
Cellulitis, abscess formation, fistula,
osteomyelitis and rarely necrotizing fascitis
94. 1. The development of adequate drainage
2. Removal of the source
3. Appropriate antibiotic coverage
Clinical examination &plain radiographic assess
the status of fracture segments and hardware.
Specimen for bacterial culture & sensitivity
CT and MRI – if adjacent soft tissues are
involved.
Antibiotic of choice PG / clindamycin
95. No improvement in the level of sensation
,after 6-8 weeks –baseline neurologic
function.
Surgical repair is considered after 6 months.
96. APPROPRIATE DIAGNOSIS
ANATOMIC REDUCTION
STABILIZATION OF THE FRACTURED SEGMENTS
USING OCCLUSION AS A GUIDE.
STABLE INTERNAL FIXATION
98. Complications
• Socioeconomic groups
• Infection (James, et. al.)
• Delayed healing and malunion. Most commonly caused by infection
and noncompliance
• Nerve paresthesias in less than 2%
99. Conclusions
• With multiple techniques available, there is still controversy over the
best treatment for each type of mandible fracture
– The decision is a clinical one based on
patient factors, the type of mandible
fracture, the skill of the surgeon, and the
available hardware
– Further studies are in progress
100. Reduction: Reduction of a fracture means
the restoration of functional alignment of
the bone fragments.
• In the dentate mandible reduction must
be anatomically precise.
• The teeth are used to assist the
reduction, check alignment of the
fragments and assist in the immobilization.
101. • Whenever the occlusion is used as an
index of accurate reduction, it is
important to recognize any pre- existing
occlusal abnormalities such as an anterior
or lateral open bite.
• Widely displaced, multiple or extensively
comminuted fractures may be impossible
to reduce by means of manipulation of the
teeth alone, in which case open operative
exploration becomes necessary.
• Gradual reduction of fractures can also be
carried out by elastic traction.
102.
103. Following accurate reduction of the
fragments, the fracture site must be
immobilized to allow bone healing to
occur.
Period of Immobilization:
The period of stable fixation required to
ensure full restoration of function varies
according to the site of fracture, the
presence of otherwise of retained teeth in
the line of fracture, the age of the patient
and the presence or absence of infection.
104. A Simple guide to the time of immobilization
for fractures of the tooth bearing area of
the lower jaw is as follows:
Young adult
With
Fracture of the angle
Receiving
Early treatment 3 weeks
In which
Tooth removed from fracture line.
105. If :
Tooth retained in fracture line : add 1 week.
Fracture at the symphysis : add 1 week
Age 40 years and over : add 1 or 2 weeks
Children and adolescents : subtract 1 week.
106. a. Osteosynthesis without intermaxillary
fixation:
i. Non – compression small plates
ii. Compression plates:
iii. Mini – plates
iv. Lag screws
107. b. Intermaxillary fixation:
i.Bonded brackets
ii. Dental wiring:
Direct :
Eyelet:
iii. Arch bars
iv. Cap splints
108. c. Intermaxillary fixation with osteosynthesis:
i. Transosseous wiring
ii. Circumferential wiring
iii. External pin fixation
iv. Bone clamps;
v. Transfixation with Kirschner wires.
109. Osteosynthesis without intermaxillary
fixation:
Non Compression small plates:
Made of stainless steel or Titanium.
They are available in various sizes and
shapes.
These plates are however, larger than the
more recently designed mini – plates,which
is used to incorporate compression across
the fracture.
110. Compression Plates:
•Bony union is achieved by firm
approximation of the fragments under
pressure.
•They are of 2 types – Dynamic compression
plate(DCP) & Eccentric dynamic compression
plate (EDCP)
•It is necessary to apply these plates to the
convex surface of the mandible at its lower
border.
•There is a tendency for the upper border &
the lingual plate to open with the final
tightening of the screws.leading to distortion
of occlusion & opening of the fracture line.
111. • In order to overcome these problems
various designs of compression plate have
been devised.
• It is necessary to apply a tension band at
the level of the alveolus before tightening
the screws.
•This can be in the form of an arch bar
ligatured to the teeth or as a separate plate
with screws penetrating the outer cortex
only.
•Disadvantages :The procedure tends to be
lengthy & needs expertise. The fixation
plate is bulky.
112.
113.
114. Mini – plates:
•Champy et al. (1978) introduced a mini-plate
system customised for use in
mandibular fractures.
• Originally fashioned in stainless steel,
they are now widely available in titanium.
• Non-compression mini-plates with screw
fixation confined to the outer cortex allow
the operator to place plates both
immediately sub-apically as well as at the
lower border.
115. •All plates can be inserted by an intra-oral
approach without the need for
intermaxillary fixation.
•Mini –plate osteosynthesis can be used in
virtually all types of mandibular body
fracture.
• Plates can be inserted via an intra – oral
approach using special cheek retractors and
protective sleeves passed through the soft
tissues of the cheek. It is only necessary to
reflect periosteum from the outer plate of
bone.
•The plates can usually be left in
permanently without causing trouble.
116.
117.
118. Lag screws
•A few oblique fractures of the mandible can
be rigidly immobilized by inserting two or
more screws whose thread engages only the
inner plate of bone.
•The hole drilled in the outer cortex is made
to a slightly larger diameter than the
threaded part of the screw.
•When tightened the head of the screw
engages in the outer plate and the oblique
fracture is compressed. At least two such
lag screws are necessary to achieve rigid
immobilization.
119.
120. Intermaxillary fixation:
Bonded modified orthodontic brackets
Fractures with minimal displacement in patients
with good oral hygiene can be immobilized by
bonding a number of modified orthodontic
brackets onto the teeth and applying
intermaxillary elastic bands.
121. Dental wiring is used when the patient has a
complete or almost complete set of suitably
shaped teeth.
0.45nim soft stainless steel wire has been
found effective.
122. Direct Wiring
•The middle portion of a 6 inc (15cm) length
of wire is twisted round a suitable tooth and
then the free ends are twisted together.
•Similar wires are attached to other teeth
elsewhere in the upper and lower jaws and
then after reduction of the fracture the
plaited ends of wires in the upper and lower
jaws are in turn twisted together.
123. Interdental eyelet wiring :
• Eyelets are constructed.
• These eyelets are fitted between two teeth.
• About five eyelets are applied in the upper
and five in the lower jaw and then the eyelets
are connected with tie wires passing through
the eyelets from the upper to the lower jaw.
124.
125. Arch Bars
• Useful when the patient has an insufficient
number of suitably shaped teeth to enable
effective interdental eyelet wiring.
• Many varieties of prefabricated arch bar are
available and the Winter, jelenko and Erich type
bars have all proved effective.
126.
127. • Arch bars should be cut to the required
length and bent to the correct shape before
starting the operation.
• As the mandibular fragments are displaced
owing to the fracture the bar is bent so that it
fits around the upper arch.
• The arch bar is wired to successive teeth
on each side working backwards to each third
molar area.
128. • It is important to retighten each wire before
the twisted portion is cut and trucked into a
position where it will not irritate the tissues.
Cap Splints:
Silver cap splints were for many years the
method of choice for the immobilization of all
jaw fractures.
129. Indications for the use of cap splints are as
follows:
1. Patients with extensive and advanced
periodontal disease when a temporary
retention of the dentition is required during
the period of fracture healing.
2. To provide prolonged fixation on the
mandibular teeth in a patient with fractures
of the tooth – bearing segment and bilateral
displaced fractures of the condylar neck.
130. Intermaxillary Fixation with osteosynthesis:
Although some simple fractures of the tooth –
bearing portion of the mandible can be
accurately and adequately treated by
intermaxillary fixation alone, in practice that
fixation is frequently reinforced by open
reduction of the fracture and some type of
non – rigid osteosynthesis
131. Transosseous Wiring:
• In principle holes are drilled in the bone
ends on either side of the fracture line
after which a length of 0.45mm soft
stainless steel wire is passed through the
holes and across the fracture.
• After accurate reduction of the fracture
the free ends of the wire are twisted
tightly,cut off short and the twisted ends
tucked into the nearest drill hole.
132. Circumferential wiring:
A few oblique fractures of the body of the
mandible can be reinforced by passing a
length of 0.45mm soft stainless steel wire
circumferentially.
External pin fixation:
The technique consists of inserting into
each major bone fragment a pair of 1/8 inch
(3mm) titanium or stainless steel pins which
diverge from each other, but are connected
by a cross bar which is attached to each pin
by means of universal joints.
133. The main indications for the use of pin
fixation for mandibular fractures may be
summarized as follows:
1. To provide fixation across an infected
fracture line
2. To maintain the relative position of
major fragments in extensively
comminuted fractures.
3. In the treatment of bimaxillary fractures
when a ‘box frame’ form of fixation is
employed.
134. Fractures of the edentulous
mandible
•The physical characteristics of the body of
the mandible are altered considerably
following the loss of the teeth.
• Vertical depth of the subsequent denture –
bearing area is reduced.
•The endosteal blood supply from the
inferior dental vessels begins to disappear.
135. Reduction
• For the reasons already stated, precise
anatomical reduction is not necessary.
• The reduced cross- section of bone fractures
of thin mandibles means that displacement
occurs more readily and in this situation open
reduction may be only way to restore adequate
bone contact.
136. Methods of immobilization
There is no uniformly accepted method.
The methods of treatment currently in
common uses are:
1. Direct osteosynthesis:
a. Bone plates
b. Transosseous wiring.
c. Circumferential wiring or straps
d. Transfixation with Kirschner wires
e. Fixation using cortico – cancellous bone
graft.
137. 2. Indirect skeletal fixation:
a. Pin fixation
b. Bone clamps
3. Intermaxillary fixation using gunning –
typesplints:
a. Used alone
b. Combined with other methods.
138. Direct osteosynthesis
Bone plates:
Bone plates are particularly useful for
displaced fractures of the edentulous
mandible, particularly those at the angle.
The reduced depth of bone in the
edentulous mandible favours the use of non –
compression mini-plates.
139.
140. Transosseous Wiring
Many simple edentulous fractures can be
satisfactorily immobilized by direct
transosseous wires.
Transosseous wires do not provide rigid
osteosynthesis and supplementary fixation
may be necessary.
Circumferential wiring or straps:
Oblique fractures of the edentulous
mandible can be most effectively and simply
immobilized by circumferential wires.
141. Primary Bone Grafting:
• A 5 cm length of rib is obtained as an
autogenous graft.
• The rib is split and the two pieces are
placed one on each side of the fractures
site in the manner of a first –aid splint
applied to a limb.
• The rib halves are lashed together by a
series of circumferential wires sandwiching
the fractured bone ends between them.
142. Indirect skeletal fixation:
• A system of bone pins joined together by rods
and universal joints, can be used in
edentulous mandibular fractures.
• The method is occasionally of practical use
when there has been extensive comminution
of a long segment particularly if this involves
the symphysis.
143. Intermaxillary fixation using gunning –
type splints:
• The dental splint described originally by
Gunning in 1866.
• If the patient is completely edentulous
immobilization is carried out by attaching
the upper splint to the maxilla by
peralveolar wires and the lower splint to
the mandibular body by circumferential
wires.
• Intermaxillary fixation can then be
effected by connecting the two splints
with wire loops or elastic bands.
144. Steps in construction:
1. Upper and lower impressions are taken
2. Plaster casts are made
3. Upper and lower base plates adapted
4. Bite blocks prepared in posterior region
only
5. Upper and lower plates with bite blocks
are constructed using heat cure acrylic
leaving the anterior region open for
feeding.
145. 6. Hooks are
incorporated in buccal
side of the bite
blocks.
7. Grooves must be
made in both gunning
splint, in the canine
region to prevent the
peralveolar and
circumferential wires
from slipping.
146. Infection
Nerve damage
Malunion
Foreign bodies
Delayed union
Non union
151. Reduction
Closed
Direct interdental
wiring Indirect
interdental wiring
(eyelet or Ivy loop)
Continuous or multiple
loop wiring
Arch bars
Cap splints
'Gunning-type' splints
Pin fixation
OOppeenn
Transosseous
wiring
(osteosynthesis)
Plating
Intramedullary
pinning
Titanium mesh
Circumferential
straps
Bone clamps
Bone staples
Bone screws
FFiixxaattiioonn
DDiirreecctt
IInnddiirreecctt
152. Methods of immobilization
(a) Osteosynthesis without intermaxillary fixation
(i) Non-compression small plates
(ii) Compression plates
(iii) Mini-plates
(iv) Lag screws
(b) Intermaxillary fixation
(i) Bonded brackets
(ii) Dental wiring
Direct
Eyelet
(iii) Arch bars
(iv) Cap splints
(c) Intermaxillary fixation with osteosynthesis
(i) Transosseous wiring
(ii) Circumferential wiring
(iii) External pin fixation
(iv) Bone clamps
(v) Transfixation with Kirschner wires
153. Young adult with
Fracture of the angle
receiving Early
treatment in which
Tooth removed from
fracture line
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154. HISTORY
William Saliceto(1210-1277) Tied the teeth (MMF)
Thomas Gilmer(1849-1931) Reveiwed the tech, introduced
Arch Bars in 1907.
Barton bandage by JOHN BARTON
Lingual-Labial occlusal splint.
Vaccum formed acrylic splint
Royal Berkshire Haio Frame
191. The general physical status should be
thoroughly evaluated.
40% associated with significant injury, 10% of
which are lethal
Cerebral contusion is common
ABC’s!
Almost never emergent
192. Dental injuries should be treated
concurrently
Reestablishment of occlusion is the primary
goal
Fractured teeth may jeopardize occlusion
Mandibular cuspids are cornerstone of Tx
Prophylactic antibiotics
193. With multiple facial fractures, mandibular
fractures are treated first
194. Prospective study of 422 pts
Infection rate 7%
50% of infections associated with fractured
or carious teeth
ORIF led to 12% infection rate
Staph, strep, bacteroides
Prophylaxis, tooth extraction
195. Prospective, 8 year study at Parkland
involving angle fractures
Nonrigid fixation had 17% complication rate
AO Recon plate had 8% complication rate
DCP had 13% complication rate
Non compression plate 3% complication rate
1st
Qtr
2 n
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3r d
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4th
Qtr
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80
70
60
50
40
30
20
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0
Ea st
West
N orth
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