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Mandibular Fracture ( part I )
Bushara PING, student in year 6th,, faculty of dentistry Phnom Penh
Classification by type of fracture
• Simple FX• Green stick Fx• Commuted • Class1• Class2 • Class3 in a edentilous
Mandibular Force
Etiology
Fracture with trauma: accident, work, fighting…… Fracture pathologic: infection, tumor,
osseoradionecrosis. bone disease: ossteoporosis,
osteomalacia*,Rickets*,intoxication ( with mercure, phosphore..)
osteomalacia*: soften of the bone typically through a deficiency of Vitamin D or Calcium.
Rickets* ( rachitis) : Vit D deficiency in childrend.
Etiology
Anatomic conditions: impacted teeth, the region with lower resistence, edentilous patient with atrophy of the mandibular.
Etiology
Anatomical codition Fracture pathologic
Occlusion Examination
• Posterior contact & anterior open bite > bilateral Condylar or angle Fx
• Posterior open bite is common with the Fx Parasyphysia
• Unilateral open bite > Fx parasymphysia or angle Fx ( one side)
• Retrognathic Occlusion > Fx angle or condylar• Open bite on opposite site and deviation of the
chin to the Fx side > Fx condylar neck
Mandibular Force
Mal occlusion
Fx partial parasymphysia with Fx alveolo-dentair khmer soviet hospital
How to fix the fracture?
• Maxilomandibular Fixation ( MMF): fix for 30 to 40 day. But can’t used with the open fracture. ( using ache base and wire)
• (Open reduction) Non-rigid fixation:using wire punch the bone and fix.
• (Open reduction) Rigid fixation: using Plate.• External pin fixation:• Lag scrow, DCP
MMF
MMF
MMF
Ivy Loop faxation
Non-Rigid fixation
Non rigid fixation ( wire opacity in radiography)
Intubation technic
Rigid fixation ( ORIF)
ORIF*= Open Reduction and Internal Fixation
Titanium plate using in rigid fixation
External Pin Fixation
Lag screw, DCP
General principle for treatment
• Tetanus• Nutrition• Almost Fx can be open fracture > Reduction
and Fixation• Postoperative monitor• Oral care H2O2, irrigation, soft tootbrush• Two weekly chack.
Reference
• Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)• Maladies des parties molles de la cavité buccale, Dr Keam
Born• Master Dentistry Vol 1: oral and maxillofacial surgery,
Radiology, Pathology and Oral Medicine ( Paul Coulthard, Keith Horner, Philip Lloan, Elizabth Theaker)
• Oral Surgery: Fragiskos D. Fragiskos ( Springer-Verlag Berlin Heidelberg 2007)
Next Session?
• Complication post-operation.
• Tooth luxation.• Fx mandibular in
Children, how to menage the eruption of Permanent tooth.
• Fixation in edentulous patient
Thank you for you attention
Facture Mandibular part II• Injury to the tooth Extraction if the root fracture.• Classification of tooth luxation:Concussion: without displacement
> periodontium traumaSubluxation: displacement>
periodontium traumaLuxation: could be extrusive,
intrusive or lateral direction displacement.
Avulsion: completely displacement.Best chance of saving tooth is re-
implanted in under 1 hrs since avulsion ( master dentistry table 8 page 124)
Example of dental injuries
Special consideration in pediatric
Deciduous tooth and Permanent tooth• could be treat with MMF for 2 or 3 weeks. ( if
Rigid fixation can harm to Permanent bud)• It is header to place wire to ach base, because
of the crown is close to gingival margin.• NOTE: remember that mandibular fracture of
child can due to Ankylosing TMJ > facial deformation, So prevent with weekly mobilisation.
Reference: Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)
Special consideration edentulous patient
• Splint • Denture ( patient have denture)
• Circumandibular and Cirumzygomatic fixation
HOW TO CREATE SPLINT FIXATION?
Splint fabrication
To make the splints, an impression is first made. Next, a cast made out of plaster or stone is made from the impression. Then acrylic splints are made with holes for wiring and grooves for circumandibular and circumzygomatic fixation.
Splint fibracation
Diagram illustration
Ooy!!!!
Ooy!!!!!!
Fixing with Denture prepatation
Edentulous patients may undergo closed reduction by wiring the patient's dentures to his jaws using circumandibular and circumzygomatic wires.
Complication
• Socioeconomic condition greatly affectsoutcome• Infection - In a prospective study by Jamesof 422 fx -infection rate was 7% of which50 % were associate with fx or cariousteeth, of the 177 fx requiring ORIF, 12 %became infected
Complication
• Delayed healing(3%) and nonunion(1%)– most common cause in infection– second most common cause is noncompliance– inadequate reduction, metabolic or nutritionaldeficiency can play a role
• Nerve paresthesia’s (Inf. Alveolar nerve) occur in2%• Malocclusion• TMJ problems
Unilateral open bite
First AidAdult
Childrend
Reference
• Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)• Maladies des parties molles de la cavité buccale, Dr Keam
Born• Master Dentistry Vol 1: oral and maxillofacial surgery,
Radiology, Pathology and Oral Medicine ( Paul Coulthard, Keith Horner, Philip Lloan, Elizabth Theaker)
• Oral Surgery: Fragiskos D. Fragiskos ( Springer-Verlag Berlin Heidelberg 2007)
• Education Program: Trauma life support Training Phnom Penh 8-13/10/2010 Bernard M. Jaffe, M.D Professor of surgery Tulane University
Download Link:
• http://www.4shared.com/file/lzJa0ysg/Mandibular_Fracture.html
Thank you for attention