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.
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.
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
A fractured neck of femur (NOF) is a serious injury, especially in older people. It is likely to be life changing and for some people life threatening.
Neck of femur fractures (NOF) are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral density, predisposing to fracture. Elderly osteoporotic women are at greatest risk.
Cervical Hybrid Arthroplasty by Pablo Pazmino MDPablo Pazmino
This video explains Cervical Arthroplasty in combination with a fusion. When people have more than one cervical disc which has degenerated or which has sustained a traumatic rupture they may need a procedure to address both levels. These herniations may begin to affect the surrounding nerves and/or spinal cord. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Cervical Herniations/ Radiculopathy at multiple levels feel free to look us up online www.beverlyspine.com or call toll free 1-8SPINECAL-1
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
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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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
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
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
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2. Contents.
Introduction.
History.
Surgical anatomy
Epidemiology.
Classification systems
Clinical examination
Radiographic features and diagnosis
Treatment planning
Special considerations
Conclusion
References
3. Introduction.
Strongest at the same
time most frequent
fractured facial bone!
Mandibular fractures
occurs twice as often as
mid-facial fractures
For better management
of this scenario an OMFS
surgeon should be
exposed to the minute
details of the anatomy
and different surgical
considerations.
4. History.
Egyptian Papyrus (1650 BC) –
Examination, diagnosis &
treatment.
Hippocrates – Approximation of #
segments.
Salerno, Italy (1180) – Proper
occlusion.
1492, the book Cyrurgia by
Guglielmo Salicetti – use of IMF.
John Barton - Barton Bandage
5. 1860 GILMER GILMERS WIRING & FULL ARCH BARS
1900 MAHE PLATING KIT SIMILAR TO MODERN
SYSTEMS
1920 F. RISDON RISDONS WIRING
1961 LUHR DYNAMIC COMPRESSION PLATES
1970 BRONS & BOERING LAG SCREWS
1973 MICHELET MINIPLATES FOR MAND
OSTEOSYNTHESIS
1978 CHAMPY MINIPLATE OSTEOSYNTHESIS
PRINCIPALS
6. Surgical anatomy
Strongest facial bone
Parabola shaped bone
Angle of curvature is 110-140°
Mandible is the 2nd bone to ossify
Composed of dense cortical bone encloses
medullary bone.
7.
8. Weak areas of mandible
Junction of the ramus and the body ( angle of the
mandible) are fractured commonly.
Symphysis region - junction of two individual bones.
Junction between alveolar bone & basal mandibular
bone.
Parasymphyseal region - lateral to the mental
prominence, incisive fossa and mental foramen.
Presence of impacted tooth, canine with long roots
further weakens the mandible.
9. Age changes of mandible.
Mental foramina.
child – near inferior border.
old age – near alveolar ridge.
Ramus angle.
child & old – obtuse
Alveolar ridge
Blood supply
10. Safe distance in mandible.
Average thickness of
Cortex in symphysis &
parasymphisis
region is 2.5 mm
Average thickness of
Cortex in premolar &
Body region is 3.5 mm
11. Distance between I.A.
Canal & cortex
At bicuspid - 4.0 mm
Molar region - 5.9 mm
Anteriorly distance
Between adjacent
Root apices is 3.7 mm
Posteriorly distance
Between adjacent
Root apices is 6.3 mm
12. Muscle attachments
Muscles of mastication
1. Temporalis (1)
2. Masseteer(14)
3. Medial pterygoid
4. Lateral pterygoid
Muscles on lingual aspecct
of mandible
1. Geniohyoid
2. Genioglossus
3. Mylohyoid
4. Ant belly of digastric
13.
14. Blood supply.
• Helps in the healing of
fractured bone.
• Endosteal blood supply via
inferior dental artery & veins.
• Peripheral blood supply -
Periosteum
16. Champy’s principles
Forces of mastication produce
tensional forces on upper border &
forces of compression on lower
border.
Champy put forward the lines
where plates & screws have to be
placed - “ideal osteosynthesis
lines”.
It corresponds to course of a line of
tension at base of the alveolar
process.
Only in symphysis region, 2 plates
19. Classification
1. Dictionary classification
2. Kruger’s classification
3. Anatomical location ( Row & killey, Dingman and
Natwig)
4. Kazanjian's classification
5. AO classification
6. On mechanism of action
7. According to direction and favorability of muscle
21. Kruger's Classification
SIMPLE ( CLOSED) Linear fracture lines which do not communicate
with the exterior
COMPOUND
( OPEN)
The fracture is communicating intraorally or
extraorally.
COMMUNITED Shattering of bone into multiple pieces
COMPLEX
COMPLICATED
They is adjunct injury to the adjacent nerves or
major blood vessels , joints.
GREENSTICK Only one cortex broken. Common in children
PATHOLOGICAL Spontaneous fracture as a result of normal muscle
contraction or
trauma due to increased weakness of underlying bone .
24. Rowe and Killey classification
Involving basal bone
1. Single
2. Unilateral
3. Bilateral
4. Multiple
Not involving basal bone( dento alveolar)
25. Dingman & Natvig classification
Symphysis fracture
Canine region
fracture
Body of the mandible
fracture
Angle fracture
Ramus fracture
Coronoid fracture
Condylar fracture
Dentoalveolar fracture
26. Direction & favorability of treatment
Favourable : Muscle pull is restricting the fracture
line from displacement is considered favorable
fractures.
Unfavourable: when the muscle pull is displacing the
fracture line from each other
Elevator group of muscles exert an upward forward
and medial pull
Depresor group of muscle exerts –downward and
backward pull.
27. Horizontally Favourable
Fracture line runs
downward & forward so
upward displacement
avoided
Horizontally
Unfavourable
Fracture line runs Down
Wards and Back Wards
so
upward Displacement
Unrestricted
28. VERTICALLY FAVORABLE VERTICALLY UNFAVORABLE
FRACTURE LINE RUNS FROM THE
OUTER BUCCAL PLATE OBLIQUELY
BACKWARDS AND LINGUALLY , MEDIAL
MOVEMENT RESTRICTED
FRACTURE LINE RUNS FROM THE
INNER LINGUAL PLATE OBLIQUELY
BACKWARDS AND BUCCALLY , MEDIAL
MOVEMENT UNRESTRICTED( A point more
antriorly from lingual side to point posterior on
buccal side)
29.
30. Presence or absence of teeth
Kazanjian V.H. & Converse J.M.
CLASS 1 TEETH ON BOTH
SIDES OF FRACTURE LINE
CLASS II TEETH ONLY ON ONE SIDE
OF THE FRACTURE LINE
CLASS III EDENTULOUS PATIENT
31. AO Classification
F NO. OF FRACTURE OR FRAGMENTS
L LOCATION OF THE FRACTURE
O STATUS OF OCCLUSION
S SOFT TISSUE INVOLVEMENT
A ASSOCIATED FRACTURES
32. F: NO. OF FRACTURES
F0 Incomplete fractures
F1 Single fractures
F2 Multiple fractures
F3 Comminuted fractures
F4 Fracture with bone defect
34. O: Status of occlusion
O 0 No malocclusion
O 1 Malocclusion
O 2 Edentulous mandible
35. A: Associated fracture
A 0 None
A 1 Dentoalveolar fracture
A 2 Nasal bone fracture
A 3 Zygoma fracture
A 4 Lefort I
A 5 Lefort II
A 6 Lefort III
F0-L2-O0-A 1:
Incomplete fracture ,canine region, No malocclusion with associated dento alveolar
fracture
37. History
Chief complaint
History of presenting illness
Loss of consciousness, vomiting, amnesia
Systemic examination
38. Mechanism of injury
1. Type of traumatic force
Vehicle accidents usually gives multiple compound
fracture
A broad blunt objet blow will cause usually a
communited injury as the force distribute
throughout the bone.
2. Direction of the force
Eg : An injury on chin causing symphyseal fracture is
having a high chance of associated unilateral or
bilateral condylar fracture.
3. Any pre-traumatic temporomandibular joint
dysfunction needs to be noted.
39. Clinical Examination :INSPECTION
1. Extra oral
Change in the contour of a face and swelling in the
region of mandible.
Swelling associated with ecchymosis is suggestive
hematoma with fracture.
A lacerataion on the chin
2. Intra oral
Mucosal and gingival tear
Echymosis
Occlusal changes
42. Collapsed arch and
Interfragmentary mobility
Open bite due bilateral posterior
Gagging of occlusion
Open bite and cross bite due to
Unilateral gagging of occlusion
Occlusal step with
Unilateral cross bite
43. Mandibular fracture has to be differentiated from extensive
Soft tissue injury and dentoalveolar trauma
UNILATERAL OPEN BITE
46. Radiographic features
OPG
PA View
PNS View
Lateral oblique Radiograph
Occlusal view
CT scan.
Whenever one fracture of the mandible is identified, the surgeon must always
suspect that one or more additional fractures are present.
Careful clinical and x-ray examination will assist in establishing the correct
diagnosis.
50. Because of distortion in
Symphysis Region in
an OPG , an Occlusal
View is indicated in
Symphysial fractures
Also shows Vertical
Favorability of Body
Fractures
Occlusal view
51. Peri apical
Most of the fine details with the nondisplaced linear
fracture is also visible
53. MANAGEMENT
KEEP IN MIND
- Force great enough to cause fracture to the strongest
maxillofacial bone can also cause injury to the organ systems
as well.
-Consider methodically. NOT AN EMERGENCY.
-PRIME GOAL IN TREATMENT OF MANDIBULAR FRACTURE-
-THE OLD ADAGE –Inside Out and Bottom to Top
54. We are surgeons not superheroes...
ALWAYS KEEP IN MIND THAT CLOSED
REDUCTION ALSO IS A SUCCESSFULLY
PRACTICED OPTION IN
TREATING MANDIBULAR FRACTURE
SINCE YEARS….
55. Open reduction give functional stabilisation but 25%
incidences of Facial nerve injuries are aproblem.
Endoscopic technique should be refined and refined
iinstrumentation.
56. INDICATION FOR OPEN REDUCTION
Displaced unfavourable fracture
Multiple fractures of facial bone
Bilateral condylar fracture
Edentulous maxilla
57. INDICATION OF CLOSED REDUCTION
Non-displaced fracture
Grossly communited
Edentulous mandible
Coronoid process fractures
58. Also indicated where open reduction is
contra indicated
Not advisable under GA
Gross infections
Pt. refusing open reduction
60. Bridle wire
For temporary reduction and
stabilization.
Old technique.
Wire (25 or 26 gauge) is
wrapped around two teeth on
either side of the fracture.
61. Ivy loops
A 24 gauge wire is
used.
Quick easy way to
achieve maxilla-
mandibular fixation.
62. Arch Bars
Risdon’s Arch Bar
Winter’s Arch bar
Jelenko Arch Bar
Erich’s Arch Bar
Hamilton Arch Bar
63. Risdon Wiring
Can be
advantageous in
treating primary
and early mixed
dentition.
24- 26 gauge
wire is used.
64. IMF screws
Used in minimally
displaced fractures.
In serologically positive
patients, where the
surgeon is at a high
risk of skin puncture
with arch bar
placement.
66. SUBMENTAL APPROACH
The submental approach is used to treat fractures of the anterior mandibular body and
symphysis. These fractures can usually be approached and treated intraorally.
However, depending on the difficulty or severity of the fracture, and/or the presence of
a laceration suitable, an extraoral approach via the submental route may be indicated.
An advantage to this approach is that the surgeon can easily inspect the lingual surface
of the mandible to assure optimal reduction of the fracture in this region.
67. SUBMANDIBULAR APPROACH
If using skin creases for the incision, the orientation of the scalpel
blade is parallel to the relaxed skin tension lines (RSTL).
68. Advantages:
Allows optimal manipulation of the fragments
Good control of the lingual cortex and inferior border
Variations:
The incision can either be parallel to the inferior border of the
mandible (A) or be placed in an existing skin crease (B) for
maximum cosmetic benefit.
MOST USEFUL FOR:
BODY Fracture
ANGLE Fracture
Communited
Atrophic mandible
69. RETROMANDIBULAR APPROACH
-A vertical incision through skin and
subcutaneous tissue is made,
extending from just below the ear
lobe towards the mandibular angle.
-It should parallel the posterior
border of the mandible.
72. Most useful for:
High condylar fractures/
Zygomatic arch
fractures
Useful for low ramus #
73. EXISTING LACERATION APPROACH
The surgeon may elect to extend the
laceration to provide adequate access
to the fractured area, following the
relaxed skin tension lines (RSTL).
Bacterial contamination is not a
contraindication for the use of existing
lacerations for surgical approach.
74. INTRA ORAL SURGICAL APPROACHES TO
MANDIBLE
Skeletonization:
Mental nerve to be taken care of
during fixation.
75. Vestibular incision Vestibular plus
envelope incision
Where there is no third molar present, or
where one is present but is to be left in
place, a purely vestibular incision
approximately 5 mm away from the
attached gingiva is made.
When an erupted third molar is to be
removed, the incision must incorporate
the attached gingiva around the buccal
side of the tooth.
78. A large variety of plates are available for application
to the mandible. Types of plates include:
Mandible plates 2.0
Locking plates 2.0
(Locking) reconstruction plates
Dynamic compression plates
Universal fracture plates
79. Mandible plate 2.0
Plate thickness of 1.3 mm or less. Therefore, small and medium profile
locking plates 2.0 and mandible plates 2.0 are considered miniplates.
81. Advantages of locking plate
Conventional plate/screw systems require precise
adaptation of the plate to the underlying bone.
normal plate system compress the bone to the screw and
get maximum fixation
Locking plate as the screws are tightened get locked with
the plate and attaining stability.
83. Reconstruction plates
The comminuted zone can then be simplified to reduce the smaller fragments into one
large fragment by using miniplates.
This is best done by starting at the superior border (alveolar process).
84. After a framework has been created at the superior border, the
simplification process is continued at the inferior border.
Reduction of the fragments is done manually or with the use of
elevators, bone clamps, or bone hooks.
85. Dynamic compression plates
This illustration shows dynamic compression plates
2.4. Screws inserted bicortically are needed when
using 2.4 plates
86. Compression is obtained by tightening screws down a ramped
hole design. This is the spherical gliding principle.
The compression holes are drilled eccentrically to allow for
compression.
87. The plate must be overbent slightly to close the lingual cortex.
88. A miniplate with screws inserted
monocortically is used to avoid
damage to the tooth roots.
Heavier compression plates (at
least 4-hole) is placed at the
inferior border (compression
zone).
91. Symphysis & Parasymphysis # management
1. CLOSED REDUCTION
2. OPEN REDUCTION
• Two lag screw fixation
• Lag screw fixation
• One plate and arch bar
• Two plates
1.CLOSED REDUCTION
2.OPEN REDUCTION
• Two plates
• Reconstruction plate
SIMPLE FRACTURES COMPLEX FRACTURES
92. One plate and arch bar
Indication : less vertical height of symphysis region
relatively inexpensive.
2.0 mm screw, 6 mm in length a 6-hole locking plate 2.0
93. Two plate fixation
2.0 mm screw, 6 mm in length
- In cases where an arch bar
is not possible because of
missing teeth, loose teeth, or
the objection to using an arch
bar.
-The advantage of using two
miniplates is that they are
easy to contour and to secure
to the mandible using
monocortical screws.
-Are readily available in most
operating rooms.
They can be applied very
rapidly and provide stable
fixation when two are applied.
94. Plating for symphysis and para symphysis
fracture
After plating according to
surgeons choice confirmation
of reduction is important
There must be no gap at the
lingual aspect. Such a gap
would lead to occlusal
disturbance and mandibular
widening.
95. Because the mandibular symphysis undergoes twisting during
function, two mini-plates can prevent such motion from
occurring.
96. SYMPHYSIS PARA SYMPHYSIS COMPLEX
FRACTURES
TWO PLATE (BASAL TRIANGLE)
RECONSTRUCTION (PLATE BASAL TRIANGLE)
COMMINUTED (BASAL TRIANGLE)
97. TWO PLATE (BASAL TRIANGLE
Can be done by using one reconstruction plate or two
plates
Plates along the inferior border being a heavy locking plate
2.0 of large or extra-large profile
- Sequence of plate insertion
The superior plate is inserted first.
98. Plate selection
Superior border
• 4- or 6-hole mandible plate 2.0 with or without
center space
• 4- or 6-hole small profile locking plate 2.0 with or
without center space
Inferior border
• 6- or 8-hole large profile locking plates 2.0
• 6- or 8-hole extra-large locking plates 2.0
99. Comminuted basal triangle
-It should be a load bearing plating
-A locking reconstruction plate
2.4 should be used.
-The plate must be long
enough there can be a
minimum of three or preferably
four screws on each side of the
fracture.
-The screws adjacent to the
fracture should be at least 7
mm away from the fracture
line.
-Most commonly there will be
100.
101. MANDIBULAR BODY FRACTURES
SIMPLE FRACTURES COMPLEX FRACTURES
1. CLOSED REDUCTION
2. OPEN REDUCTION
-One miniplate
-Two plates
-One large plate
OPEN REDUCTION
Two plates
Reconstruction plate
102. One miniplate
The following screws and plates can be used
4- or 6-hole mandible plate 2.0 with or without center
space
4- or 6-hole small profile locking plates 2.0
4- or 6-hole medium profile locking plates 2.0
Indication
All teeth in place
Single fracture line
Minimal displacement
103. Two plate
Sequence of plate insertion
The superior plate is inserted first in order to
achieve preliminary fixation
• 4- or 6-hole mandible plate 2.0 with or
without center space
• 4- or 6-hole small profile locking plate 2.0
with or without center spaceSuperior
border
• 4- or 6-hole mandible plate 2.0 with or
without center space
• 4- or 6-hole small profile locking plate 2.0
• 4- or 6-hole medium profile locking plate
2.0
• 4- or 6-hole large profile locking plate 2.0
(straight or curved)
Inferior
border
This option offers additional stability compared with a single miniplate fixation
Specially indicated in transitional areas like ramus and angle
104. One large plate
Reconstruction plates are commonly used if the
fracture is associated with additional factors: eg,
delayed fracture treatment, infection.
One of these plate can be chosen for inferior border
6- to 8- hole large profile locking plate 2.0
6- to 8- hole extra-large profile locking plate 2.0
6- to 8- hole locking reconstruction plate 2.4.
105. COMPLEX BODY FRACTURE
TWO PLATE
• A two plate osteosynthesis is performed in
body fractures with a basal triangle.
RECONSTRUCTION
PLATE
• A load-bearing fixation is indicated for the
open surgical treatment in all types of
comminuted fractures in the mandibular body.
106. TWO PLATE
• 4- or 6-hole mandible plate 2.0
with or without center space
• 4- or 6-hole small profile
locking plate 2.0 with or
without center space
Superior
border
• 6- to 8-hole large profile
locking plates 2.0
• 6- to 8-hole extra large profile
locking plates 2.0
Inferior
border
107. Reconstruction plate
Indicated in complex comminuted fracture
Lower border is lated with locking 2.4
Insert a 2.4 mm locking head screw of
appropriate length
108. MANDIBULAR ANGLE AND RAMUS
FRACTURE
SIMPLE FRACTURES COMPLEX FRACTURES
1. CLOSED REDUCTION
2. OPEN REDUCTION
-Wire
- Miniplate at the external-
oblique ridge
- Two miniplates
- Reconstruction plate
1. CLOSED
REDUCTION
2. OPEN REDUCTION
-Two plates
-Reconstruction plate
109. Single miniplate
INDICATION : Isolated undisplaced fracture of angle
-Plating an be done accoding to surgeons choice from 4 hole and 6 hole
miniplates.
-If adequate bone is not there then 6 hole is opted
-minimum size of mandibula miniplate is 2.0. Here surgeon chose
for more rigid fixation that is 2.0 locking and goes on
112. Choice of plate
• The surgeon must choose whether to
use a 4- or 6-hole miniplate along the
oblique ridge in the angle region
Upper
border
• 4- or 6-hole mandibular plate 2.0 with or
without center space
• 4- or 6-hole locking small profile plate 2.0
• 4- or 6-hole locking medium profile plate
2.0
• 4- or 6-hole locking large profile plate 2.0
Lower
border
113. Reconstruction plate
Indications
-Simple fractures that have been infected for several
days or weeks
-Fractures that extend through an angle where the
height of the bone is much diminished
116. Indication
Control of top of the basal triangle is required
Two plate is easier than reconstruction plate fixation
117. • A 2.0 miniplate
Superior
border
• 6- to 8-hole medium profile
locking plate 2.0
• 6- to 8-hole large profile locking
plate 2.0 (straight or prebent)
• 6- to 8-hole extra large profile
locking plate 2.0
Inferior
border
123. If the fractures are located unilaterally close to each other, the intermediate
fragment is fixed with long spanning adaptation or more frequently reconstruction
plates along the inferior border.
124. If the fracture lines are located further apart,
One fracture is rigidly fixed while the other is commonly fixed with a less rigid
osteosynthesis, eg, a single plate.
Fractures in the tooth-bearing area of the anterior mandible are
generally treated first to establish the ideal occlusion. Fractures in the nontooth-
bearing area (posterior body/angle/ramus/condyle) are usually treated secondarily.
125. BILATERAL FRACTURES
The most common
combination of
fractures is an angle
combined with a
contralateral fracture
through the body or
symphysis.
126. Simple right angle fracture fixed with a miniplate in the external
oblique line and simple left body fracture fixed either with two
plate or single plate on lower border
127. Teeth In The Line Of Fracture
Commonly, there are impacted wisdom teeth associated with mandibular
angle fractures..
The surgeon can either remove the offending tooth or leave it in place if it
is thought not to compromise the result of fracture treatment.
Indications to leave teeth in the line
of fracture
•Tooth not interfering with
reduction and fixation of
fracture.
•If tooth removal requires
removal of excessive amount of
bone
•Tooth that is in good condition
and assists in establishing
occlusion and reducing the
fracture.
128. Indications for removal of teeth in the line of fracture
•Tooth luxated from its socket and/or interfering with reduction of the fracture.
•Tooth that is fractured .
•Tooth with advanced dental caries carrying a significant risk of abscess during
treatment.
•Tooth with advanced periodontal disease with mobility which would not contribute to
establishment of stable occlusion.
•Tooth with existing pathology such as cyst formation or pericoronitis.
129. Involvement of alveolar area
Routine diagnosis of alveolar fractures should
include an OPG. Periapical and occlusal dental x-
rays can be beneficial.
OPG showing a right body mandibular fracture with
an associated alveolar component.
130. Alveolar process fractures can
usually be treated by reduction
and fixation with an arch bar
that must be maintained for
approximately 6 weeks to provide
time for the fracture to heal.
As an alternative, open
reduction and internal
fixation may be used in
selected isolated alveolar
fractures and mostly in
those associated with more
severe mandibular
fractures.
131. Alveolar fragment treated using a miniplate
plate fixed with monocortically inserted
screws located adjacent to the tooth apices
The mandibular fracture was treated
with a large profile locking plate 2.0
to give enough stability along the
inferior mandibular border.
132. Infected Fractures
Open fractures can generally be regarded as contaminated
Chronic cases exhibit the typical signs of osteomyelitis.
133. pseudarthrosis must be a safe
procedure. Under these conditions,
high rigidity (absolute immobility)
is mandatory. Therefore the locking
reconstruction system 2.4 is
recommended.
Under these conditions, high rigidity
(absolute immobility) is mandatory
134. Therefore the locking reconstruction system 2.4 is
recommended.
It is important not to place any screws into the
infected bone area
The reconstruction plate functions as a bridging
device.
The extent of the exposure
must anticipate the
application of a large
reconstruction plate
allowing for the placement
of at least three screws on
either side away from the
defect.
135. The remaining dead space is filled with cancellous chips which are further used to
augment the area
137. Complications during the primary treatment
Displaced teeth and foreign body
Misapplied fixation
care is needed to avoid damage to inferior dental
canal (Compression plates and screws need
sufficient length to impinge the inner cortex)
Rigid semi rigid fixation can cause the distortion to
anatomical alignment.
Incidence of infection is more at the angle of
mandible with the fracture involved third molars.
138. Late complications
Mandible has an impressive capacity to heal by itslef
providing some bone contact is present.
The use of IMF can mask the minor occlusal
derrangement after the fixation.
Inadequate reduction can cause gross derangement
in occlusion and later malunion of the bone.
Malunion is common . Not nonunion
139. Delayed and non union
DELAYED UNION : If the time taken to heal the
mandibular fracture healing is protracted unduly then
it is referred as delayed union.
Healing process is disturbed due to infection or
general factors like osteoporosis and nutritional
defficiency.
140. NON UNION
Fracture is not only not united but will not unite on its
own.
RADIOGRAPH : shows rounding off and sclerosing
of bone ends.
PREVENTABLE CAUSES OF NON UNION :
1. Infection of the fracture site.
2. Inadequate immobilization.
3. Unsatisfactory apposition of bone ends with soft
tissue interposition.
141. CAUSES WHICH IS IMPOSSIBLE OR VERY
DIFFICULT TO OVERCOME
1. Ultra thin edentulous mandible in an elderly debiliated
patient.
2. Loss of bone and soft tissue as a result of severe trauma
eg. Missile injury
3. Inadequate blood supply to fracture site,
eg. Post radiotherapy
143. Transbuccal instrumentation extends the
versatility of transoral approaches.
the posterior divisions of the mandible are
pierced from externally. Via this transbuccal
route a special instrumentation is inserted:
Control and guidance of the procedure is done
simultaneously from the external side and the
internal approach. In the clinical situation
(contrasting in contrast to this illustration) the
soft tissues are less retracted.
144.
145.
146. ENDOSCOPIC APPROACHES
-Transoral approach : 7 years supplimentary study to evalate the outcome of transoral
endoscopic approach in condylar fractures
-Between 2005 and 2012, 50 patients with condylar fractures underwent endoscope-
assisted reduction surgery.
-There was no facial nerve damage or transitory hypoesthesia, and there were no visible
scars after the surgery.
-Transoral endoscope-assisted treatment is a challenging but reliable method with lower
morbidity and a rapid recovery.
It should be emphasized that endoscopy augments, rather than replaces, the
'time tested' principles of adequate skeletal exposure, accurate fracture reduction,
and appropriate internal fixation.
147. CONCLUSION
Has already been stressed throught the seminar
mandibular fractures are common occurring. As a
omf surgeon we need to update ourselves regarding
the various treament options and choose the one
that is most suitable for for patients.
For better management of this scenario an OMF
surgeon should be exposed to the minute details of
the anatomy and different surgical considerations.
148. References.
Oral & maxillofacial trauma- Fonseca,vol 1
Maxillofacial Injuries- Rowe & Williams
Fractures of he facial skelton - Peter Banks
Textbook of oral & maxillofacial surgery by Peter Ward
Booth.
Textbook of oral & maxillofacial surgery by Neelima
malik.
Killeys - fractures of the mandible
Fgd
Angle bcz horizontal body comprise of dense cortical plate with a core of cancellous bone whre ramus comrise of dense corial but vry littele cancellous bone within. So different density of bone joint prone to fracture
Supine position
One condyle is opened otherwice faciak appearance will collapce and gives forshortened facial appearance.
Carlis and glickman
Note that the two posterior holes of the plate are located medial to the external oblique ridge and the two anterior holes are placed along the lateral cortex.
5. Fixation