The document discusses mandibular fractures, including the most common site being the parasymphysis. It covers surgical anatomy, classification systems, diagnosis, treatment approaches like closed or open reduction, and complications. Treatment involves reestablishing occlusion through methods like intermaxillary fixation or rigid fixation for displaced fractures. Infection is the most common complication, ranging from 5-10%, and treatment approach, fixation technique, and surgeon experience can impact complication rates.

1. Mandibular Fracture: Symphysis
; Para-symphysis and Body
Moderated By: Dr. Aviral Verma
Made by: Gauri Bargoti

2. Contents
 Introduction
 Surgical anatomy
 Biomechanical consideration
 Incidence
 Etiology
 Classification
 Diagnosis
 Treatment
 Complications
 References

3. Introduction
 Fracture of mandible occurs more frequently than any other facial fracture.
Fracture of
mandible
No gross
communication
Without significant
hard or soft tissue
loss
With gross
communication
With extensive
hard or soft
tissue loss

4. Surgical Anatomy

5. Biomechanical consideration

6. Muscle Attachment and Displacement of
fracture

7. Incidence

9. The most common fractures site was parasymphysis (39.3%). The etiology of mandibular
fractures was road traffic accidents (42.9%), followed by falls (25.9%), assaults and interpersonal violence
(20.7%), and animal injuries (10.5%)

10. Etiology

11. Classification

12. Classification
Dingman and
Natwig
Kazanian and
Converse
Rowe and Killey
Kruger
Shetty et al
Fracture line
(body)

13. Dingman and Natwig

14. Kazanian and
Converse
Class I Class II Class III

15. Rowe and
Killey
Those not
involving basal
bone
Those
involving basal
bone

16. Kruger Classification
Relation to external environment
localization Type of fracture
Dentition of jaw
with reference
to splints

17. Shetty
et
al
F
L
O
S
I
D

18. Line of fracture
 The farther forward the fracture occurs in the body of the mandible, the more the
upward displacement of those muscles is counteracted by the downward pull of
the mylohyoid muscles.

21. AO- Classification

23. Diagnosis

24. PATIENT HISTORY
A thorough history
Patient’s health history
History Of TMJ disfunction
Object causing trauma
Direction of trauma

25. Clinical Examination
Occlusion
Anesthesia; Paresthesia and Dysesthesia
Abnormal mandibular movement
Laceration; hematoma; ecchymosis
Loose teeth and crepitation on palpation
Dolor; tumor; rubor; color

26. Radiological Examination
Panoramic Examination
Lateral Oblique
PA view
Occlusal view
Periapical
Towne’s view
CT and TMJ

27. General Principles of treatment
 The patient’s general physical status should be carefully evaluated and monitored before any
consideration of treating mandibular fracture.
 Diagnosis and treatment of mandibular fractures should be approached methodically, not with an
emergency-type of mentality.
 Dental injuries should be evaluated and treated concurrently with treatment of mandibular fracture.
 Reestablishment of occlusion is the primary goal in the treatment of mandibular fractures.
 With multiple facial fractures, mandibular fractures should be treated first.
 Intermaxillary fixation time should vary according to the type, location, number, and severity of the
mandibular fractures, the patient’s age and health, and the method used for reduction and
immobilization.
 Prophylactic antibiotics should be used for compound fractures.
 Nutritional needs should be closely monitored postoperatively.
 Mandibular fractures can be treated by closed reduction

28. Teeth are often injured with mandibular
fractures
 Fractured teeth can become infected and jeopardize bone union; however, an intact
tooth in the line of fracture that is maintaining bone fragments can be protected with
antibiotic coverage.
 A second molar on an otherwise edentulous posterior fracture segment should be
maintained to prevent superior displacement of the fragment in intermaxillary fixation.
 Mandibular canines are the cornerstone of occlusion and should be maintained at all
costs.
 Some teeth are not critical to restoration and can be removed when their prognosis is
doubtful and when maintenance may adversely affect fracture treatment.
 Some fractured teeth cannot be salvaged, no matter how critical they may be

29. Indication for closed reduction
Non displaced favorable fracture
Grossly comminuted fracture
Fracture exposed by significant loss of tissue
Edentulous mandibular fracture
Children with developing dentition

30. Indications for open reduction
Unfavorable Displaced fracture
Multiple Facial Fracture
Edentulous mandible with Severe displaced fragments
Edentulous maxilla opposing mandible
Malunion
Delay of treatment and interposition of soft tissue between mandibular fragments
Medical condition contraindicating IMF

31. Treatment

32. History

35. Closed Reduction and Fixation of
Dentulous Maxilla and Mandible
Ivy loops
Bridal wiring
Risdon wire
IMF Screws
Erich arch bars

37. Edentulous / partially edentulous mandible

38. CHAMPY’s Line of Osteogenesis

39. Surgical Approaches

40. Intraoral approach : Para symphysis and
symphysis

41. Intraoral approach: body
 The mucosa is incised to the bone with the blade positioned perpendicular to the
bone to avoid the mental nerve.
 The incision is made approximately 5 mm from the mucogingival junction to allow
adequate mobile tissue for closure. The proximal portion of the incision should be
carried along the external oblique ridge, only as high as the mandibular occlusal
plane.
 Extending the incision higher predisposes the buccal fat pad to prolapsing onto the
surgical field. The anterior surface of the ramus can then be exposed by stripping the
buccinator and temporal tendon with a notched angled retractor and periosteal
elevator.
 Once the coronoid is exposed, a curved Kocher clamp can be applied, which will act
as a self-retaining retractor

42. Rigid Fixation

48. Complications in fracture healing
Infection and teeth in line
Delayed healing and non-union
Facial widening
Malunion

49. Factors effecting complication
 Closed Versus Open Reduction.
 Different Rigid Fixation Techniques and Systems
 Antibiotics
 Extraoral Versus Intraoral Surgery
 Wire Osteosynthesis Versus Rigid Fixation

51. Summary
 From this review, it is apparent that infection is the most common type of complication
arising from the treatment of mandibular fractures. Although the incidence varies, it
appears to range from 5% to 10% (average).
 Although it would be expected that open reduction would contribute to infection, this
relationship is not evident in a review of the literature.
 Rigid fixation techniques are initially seen to result in a higher complication rate, but as
surgeons become more proficient with the procedures, complication rates fall.
 There are few studies on the incidence of permanent nerve damage associated with
mandibular fractures to allow any definitive conclusions to be reached.

52. References
 Killey’s fracture of mandible : 4th edition
 Trauma: Fonseca
 Peter wardbooth