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.
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
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.
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
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#drysocket #management #thirdmolarextraction #extractioncomplications
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
Mandibular fractures
Dr. Ahmed M. Adawy
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
Fractures of the mandible are a common form of facial injury in adults and occur most frequently in males during the third decade of life. The main causes of mandibular fractures are road traffic accidents, interpersonal violence, falls and sport injuries. Mandibular fractures are classified according to various criteria. The three main factors to consider are the cause of the fracture, the type of fracture and the site of the fracture. Clinical diagnosis as well as radiographic examinations are presented. Treatment modalities are discussed. Moreover, treatment-related complications are given.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Condylar fractures represent one of the most controversial issues in maxillofacial traumatology regarding classification, diagnoses and therapeutic management. Classification systems of condylar fracture is discussed. Diagnosis is usually based on history clinical examination and radiographic finding. Treatment ranges from observation, jaw exercises to closed or opened interventions. For years closed reduction was thought to be essentially complication-free. Several serious complications however have been reported including temporomandibular joint ankyloses, malocclusion, mandibular deviation and the generative joint pathology. The absolute and relative indications for open reduction is given. The debate between supporters of open or closed reduction is still continuing and the issue has not been resolved. However, the final choice treatment modality should takes into account the location of the fracture, age of the patient, presence or absence of other associated injuries, cosmetic impact of the surgery and presence of other systemic medical conditions.
Clinical & surgical management of the mandibular condylar process fractures has generated a great deal of controversy in maxillofacial trauma and there are many various approaches to treat this injury. Before, many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF), but recently open treatment of condylar fractures with rigid internal fixation (RIF) has become more common & acceptable. The objective of this presentation was to evaluate the factors that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages.
Maxillofacial trauma mandible /certified fixed orthodontic courses by Indian ...Indian dental academy
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Fractures of The Body of The Mandible In Maxillofacial SurgeryShahdHIbrahim
Fractures of the body of the mandible:
Introduction
Classification
History
Presentation
Examination
Radiography
Management
Complications
Post-operative Care
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,
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Suture Materials and Suturing Techniques - Presented by Dr. Prasanjit Das and group as a part of Dhaka Dental College, OMS Department weekly presentation program.
Maxillofacial Trauma and Its Emergency Management - ATLS
Presented by Dr Sabrina and group as a part of Dhaka Dental College OMS Department weekly presentation program
Dental Management of a Medically Compromised Patients - Presented by Dr. Shweta and Parray as a part of Dhaka Dental COllege OMS Department Weekly Presentation Program
Complication of Tooth Extraction and their Management - Presented by Dr. Trisha and group as a part of OMS Department weekly presentation in Dhaka Dental College
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
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
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2. What is a Fracture?
Fracture is defined as a break in structural and natural
continuity of bone
Mandibular Fracture:- Is that when fracture is
involved in the mandible.
3. Etiology
Vehicular Accidents involving (RTA) – 43 %
Interpersonal violence, Assaults – 34%
Falls – 7%
Contact sports 4 %
Industrial /work related – 10%
Pathological Fracture – unconfirmed
Studies have shown that the incidence of mandible fractures are influenced by
various etiological factors e.g.
Geography
Social trends
Road traffic legislations
Seasons
7. Emergencies Involving Mandibular
Fracture
With rare exception, mandible fractures are not surgical emergencies.
Emergencies involving Mandibular fracture happens with unfavorable
fractures involving bilateral Para-symphysis fracture pulling the anterior
part backward and compromising the airway.
Paralysis of tongue and consequently airway compromisation
8. Types of Mandibular Fracture
Simple - Includes a closed linear fractures
Compound or open
Comminuted
Greenstick
Pathologic
Multiple
Impacted
Atrophic
Complicated or complex
9. Classification by anatomic region 9
Dingman and Natvig
Condylar process
Coronoid
Ramus
Angle
Body
Symphysis
Parasymphysis
Alveolar process
10. Treatment Protocol
ATLS protocol
Primary Survey –
A-- Airway Maintenance and Cervical Spine Protection
B– Maintenance of Breathing and Ventilation
C– Circulation and Hemorrhage Control
D– Disability/Neurological Examination – AVPU
E– Exposure under proper environment
Secondary Survey – head-to-toe evaluation, including a complete
history and physical examination and reassessment of all vital signs.
Tertiary Survey -- In Hospital Care
11. Definitive In-Hospital Treatment
Reduction
Restoration of a functional alignment of the bone fragments
Use of occlusion
1. Open reduction
2. Closed reduction
Fixation
Immobilization
To allow bone healing
Through fixation of fracture line
1. Rigid
2. Non-rigid
12. Closed reduction 12
Indications
a) Nondisplaced favorable fractures
b) Grossly comminuted fractures
c) Significant loss of overlying soft tissue
d) Edentulous mandibular fractures
e) Mandibular fractures in children
f) Coronoid process fractures
g) Condylar fractures
13. Open reduction 13
Displaced unfavourable fractures Multiple fractures of the facial bones
Midface fractures and displaced bilateral condylar fracture
Fractures of an edentulous mandible with severe displacement of
fracture segment
Edentulous maxilla opposing a mandibular fracture
Delay of treatment and interposition of soft tissue between
noncontacting displaced fractures fragments
Malunion
Conditions contraindicating Intermaxillary fixation
14. Removal of a tooth from the fracture
line
ABSOLUTE INDICATION RELATIVE INDICATION
Vertical fracture
Dislocation or subluxation
Periapical infection
Infected fracture line
Acute pericoronitis
Functionless
Advanced caries
Advanced periodontal disease
Doubtful teeth
Teeth involved in untreated
fractures presenting more than 3
days after injury
15. Methods of immobilization
Intermaxillary fixation with Osteosynthesis
Intermaxillary fixation:-
Bonded Brackets
Dental Wiring :-
a). Direct wiring
b). Eyelet wiring
Arch Bars
Cap Splints
IMF Screws
Osteosynthesis without Intermaxillary fixation
16. Methods of immobilization 16
INTERMAXILLARY FIXATION WITH OSTEOSYNTHESIS
Trans-osseous wiring
Circumferential wiring
External pin fixation
Bone clamps
Transfixation with Kirschner wire
17. Methods of immobilization 17
INTERMAXILLARY FIXATION WITHOUT OSTEOSYNTHESIS
Compression plates
Miniplates
Lag screws
18. Period of immobilization 18
Young adult
with
Fracture of the angle
receiving
Early treatment
in which
Tooth removed from fracture line
if
a) Tooth retained in fracture line : add 1wk
b) Fracture at the Symphysis: add 1 wk
c) Age 40yrs and over : add 1or 2 wks
d) Children and adolescents : subtract 1 wk
3 weeks
20. Management of Coronoid Process and
Ramus Fracture
Most ramus fractures can be treated with MMF x 6 weeks
Challenges– Difficult intra-oral plating
External approach for plating is similar to that of angle fractures
Coronoid Fracture is uncommon and if it occurs it is usually associated with a
ZMC fracture
21. Management of Condylar Fracture
Most condyle fractures can be treated with MMF x 2-4 weeks
If the head is involved, MMF is limited to 2 weeks to prevent TMJ
ankyloses
Frequent scenario is a condyle fracture with contralateral
parasymphyseal, body, or angle fracture—treat contralateral
fracture with ORIF and condyle fracture with MMF x 2-4 weeks
When plating is required, an external approach is preferred
External approach is similar to the angle approach but with the
superior end of the incision brought to about 2 cm from the
earlobe.
22. Mx. Of Condylar Fracture: literature
Review
Controversial Treatment Options between closed or open reduction
Treatment aim – to recover normal TMJ function
Treatment choice depends on fracture level, amount of displacement,
adequacy of the occlusion and age.
Advantages
early mobilization of the mandible,
better occlusal results,
better function,
maintenance of posterior ramal
height,
avoidance of facial asymmetries
Disadvantages
Risk of damage to facial nerve branch
Chance of Cutaneous Scar
Open Reduction
23. Closed Reduction includes MMF with Elastics
Degree of displacement of the condylar fracture has been used in deciding between open or
closed treatment
Mikkonen et al. recommended open reduction if the condylar displacement was greater than 45
degrees in a sagittal or coronal plane
Widmark et al. recommended opening such fractures if the displacement was greater than 30
degrees.
Zide and Kent described the absolute and relative indications for open reduction of condyle
fractures
1. displacement of the condylar head into the
middle cranial fossa;
2. Impossibility of obtaining adequate occlusion by
closed reduction;
3. lateral extracapsular displacement of the condyle;
and 4
4. Invasion by a foreign body (e.g. gunshot wound.
1. bilateral condyle fractures in an edentulous
patient;
2. unilateral or bilateral condyle fractures when
splinting is not recommended for medical
reasons;
3. . bilateral condyle fractures associated with
comminuted midface fractures; and
4. bilateral condyle fractures and associated
anthological problems (e.g. lack of posterior
occlusal support)
Absolute Indications
Relative Indications
24. Management of Mandibular Angle
Fracture
One of the most common fracture sites.
Non-displaced fractures can be treated with MMF x 6 weeks
Reasons cited:
Presence of impacted third molars
Thinner cross-sectional area in the angle
region.
Biomechanical lever arm.
25. Although maintenance of the absolute rigidity on treatment of angle fractures
has been major principle, In 1973, Michelet et al, described the use of small,
malleable bone plates for treatment of angle fractures.
This led to a change from the previous belief that rigid fixation was necessary
for bone healing. Later, Champy et al. validated the technique by performing
several clinical investigations.
They determined the most stable location where bone plates should be placed
based on the ‘‘Champy’s ideal lines of osteosynthesis’’
Disadvantage:- Unable to achieve absolute immobilization
26. A prospective study performed by Amrish Bhagol et al looked at eight methods for
treating mandibular angle fractures:
1. closed reduction
2. extraoral ORIF with a large reconstruction plate
3. intraoral ORIF using a single lag screw
4. intraoral ORIF using two 2.0-mm minidynamic compression plates
5. intraoral ORIF using two 2.4-mm mandibular compression plate
6. intraoral ORIF using two noncompression miniplates
7. intraoral ORIF using a single noncompression miniplate; and
8. intraoral ORIF using a single malleable noncompression miniplate
In the study, they found out that, extraoral ORIF with a reconstruction plate and
intraoral ORIF using a single miniplate had least complications (7.5% and 2.5%,
respectively).
Thus they concluded that these two methods were best for angular fracture
management.
27. Management of Fracture of the Body
of Mandible
Simple fractures involving the body of the mandible can be effectively treated with one
miniplate along the Champy line of osteosynthesis.
Dissection should be done avoiding the damage to mental nerve which supplies the lower
lips.
Champy popularized the treatment of mandible
fractures with miniplate fixation along the ideal
lines of osteosynthesis. This is a form of load-
sharing osteosynthesis to be applied in simple
fracture patterns having an acceptable amount of
bone stock.
28. Intraoral approach best
Arch bars placed and MMF wires secured prior to incision
5 cm incision made in the gingivobuccal sulcus over the fracture, leaving a 1 cm
cuff of tissue from the mucogingival junction for closure
Dissection carried to bone
Mental nerves identified and preserved
Fracture line debrided, reduced, and MMF tightened
Four hole tension band secured between the tooth roots and mental foramen
with monocortical screws
Larger 2.3 to 2.7 mm system titanium plate is secured anteriorly through the
intraoral incision with 2-3 screws.
MMF wires cut and occlusion checked; if satisfactory, incision is closed.
29. Management of the Fracture of the
Parasymphysis and Symphysis
Parasymphyseal fractures:- Fracture lines in the canine region.
Symphysis fracture:- Any fracture line between the canine to canine.
30. Several authors have shown that miniplate fixation in symphysis
and parasymphysis is very effective way to fix this fractures.
The most common approach – transoral gingivolabial and
gingivobuccal incision.
Larger comminuted fractures, an external approach may be
necessary to accurately and rigidly fixate the mandible.
Simple symphysis fractures can be treated with two miniplates
fixation.
Single Miniplates not given – displaces on torsional forces
during functions
31. One miniplate is placed at the inferior border and a second plate is placed superiorly.
Several authors have shown that miniplate fixation along these lines is a very effective way to fixate
these fractures.
More rigid fixation should be considered for comminuted fractures
Lag Screw :- used in reduction of the lingual border of the fracture and re-establish the appropriate
intergonial distance by squeezing the mandibular angles together. For optimal strength, two lag
screws are placed.
32. Baby John et al described a case of
4.5 years old boy having been
treated with acrylic aplints.
Under sedation, upper and lower
arch alginate impressions were
taken and stone casts were poured.
An open occlusal acrylic splint was
fabricated and under GA, the
mandibular fracture was
immobilized and fixed with acrylic
splint and then retained by
circummandibular wiring. Patient
was reviewed weekly and on the
third postoperative week was
removed with LA. Patient achieved
perfect occlusion and good
masticatory efficiency.
Treatment principles of mandibular fractures in children differ from that of adults due to concerns
regarding mandibular growth and development of dentition
33. Geriatric Patient with Mandible
Fracture
Fractures of the edentulous mandible most commonly involve
the body region
Can be treated by either open or closed reduction methods.
Closed reduction with the use of prosthetics (existing dentures
or Gunning splints)
The current accepted concept in geriatric mandible fracture is
to go for open reduction and internal fixation
34. Coleman’s Sign
" There is one sign which is almost pathognomonic of
fracture of the body of the mandible, and that is an
effusion of blood into the (tissues of the) floor of the
mouth, raising its mucous membrane and producing a
characteristic bluish, tense swelling under the tongue”.
– Frank Coleman, 1912
35. Recent Developments in Mandibular
Fracture Management
Use of 3D Navigation System in Mandibular Fracture Treatment as
described by Matthias Feichtinger et al, 2001
36.
37. Use of Digital Volume Tomography (DVT) in mandibular Fracture as described by
CM Ziegler et al
The panoramic radiograph is poorly positioned due
to patient’s multiple trauma. It shows fractures at the
right mandibular angle and the left canine and
premolar region 3D reconstruction confirm the fractures at the right
mandibular angle and demonstrates clearly the
parasymphyseal fracture in the left canine region. This
3D image also shows a displaced fragment at the
inferior cortex.
Axial
DVT view
Recently endoscopic subcondylar fracture repair
has been described with encouraging results.