Mandibular fractures / fixed orthodontic courses

Fractures of the mandible

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INDIAN DENTAL ACADEMY
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Types of fractures
Simple
 Compound
 Comminuted
 Complicated
 Impacted
 Greenstick
 Pathological


Types of fractures
Simple
 Intact
soft
tissues
with
no
communication with exterior or
closed fracture
E.g.Condyle,
coronoid
process,
Edentulous mandible with intact
mucoperiosteum


Types of fractures
Compound
 Communication
open fracture

with

exterior

or

E.g.Fractures involving tooth bearing
area of dentulous mandible


Types of fractures
Comminuted
 Shattering or fragmentation of bone
E.g.Gunshot injuries, severe trauma


Types of fractures
Complicated
 Involvement of nerves, blood vessels or
joints
E.g.Involvement of inferior alveolar neurovascular bundle


Types of fractures
Greenstick
 Incomplete, without displacement of
fragments
E.g.Fracture of the neck of the condyle
in children


Types of fractures
Impacted
 Driven or
fragment

forced

into

another

No clinical movement
E.g.Maxillary and Zygomatic complex


Types of fractures
Pathological
 Spontaneous with minimal or no
trauma
 Mainly due to underlying pathology
E.g.Malignancy, benign tumors, cysts,
osteomyelitis


Facial fractures
Distribution:
 Mandible alone - 33.7% to 67.9%
 Mid face alone – 23.6% to 57.7%
 Mandible and Mid face- 8.00% to 9.28%


Mandibular fractures
Etiology:
 R.T.A’s
 Fights
 Falls
 Sport Injuries
 Industrial
 Others

Applied Anatomy
Position and shape
Structure
Nerve and blood supply
Muscle attachments


Classification
Based on site
⇒Condyle and Coronoid
⇒Ramus and Angle
⇒Body and Symphysis
⇒Dentoalveolar

Classification:Kazanzian and Converse
Based on presence of teeth
Class-I Teeth on both fragments
Class-II  Teeth on one fragment
Class–III Edentulous mandible


Classification:Rowe and Killey 
 Not Involving basal bone
E.g. Dento-alveolar
 Involving basal bone
e.g. Single unilateral
Double unilateral
Bilateral
Multiple

Classification:Horizontally
Favourable

Vertically

Unfavourable

Horizontally
Vertically


Horizontally
Favourable

Unfavourable


Vertically
Favourable

Unfavourable


Diagnosis:
History
Clinical examination
Radiographic examination


Diagnosis

History
 Health history
 Type and direction of trauma
 Object of violence


Diagnosis
Clinical features: Change in occlusion
 Numb lower lip
 Echymosis & hematoma
 Crepitation
 Pain, swelling, redness
 Loss of function
 Deformitywww.indiandentalacademy.com
or asymmetry

Diagnosis
Radiographs: O.P.G.
 Lateral oblique views
 P. A. views
 T. M. J. views
 Lower occlusal
 I. O. P. A.

Management
Primary care  aimed at general condition
Airway
Hemorrhage
Shock
Pain
Infection
Initial care of the fracture

Airway obstruction
Blood clots, vomit, bone, teeth,
denture fragments
 Inhalation
 Backward displacement of tongue
 Downward
and
displacement of maxilla

backward

Airway Maintenance
Toilet of the oral cavity
 Disimpaction of maxillae
 Stable lateral position
 Transfixation of tongue
 Gudel airway
 Endo tracheal intubation
 Tracheostomy

Infection :- Prevention
Tetanus prophylaxis
 Antibiotics
 Prophylaxis for C.S.F rhinorrhea


Control of pain
Avoid giving powerful analgesics
 Sedation with diazepam – 10 mg I-V
 Pentazocine 15 to 30 mgs


Control of pain
Disadvantage of morphine
 Depresses respiration
 Depresses level of consciousness
 Depresses cough reflex
 Constriction of pupil


Management:- Definitive
Aimed at treating fracture itself
 Reduction
 Fixation
 Immobilization
 Rehabilitation


Reduction: Types
 Closed reduction
a. Manipulation
b.Traction
Open reduction

Closed reduction
Indications
⇒Favorable fractures
⇒Comminuted fractures
⇒Edentulous fractures
⇒In children
⇒Coronoid process

Management:Methods of fixation used with closed
reduction
 Dental wiring
 Arch bar
 Cap splints
 Gunning splints
 Extra-oral pin fixation


Gunning splint

Cap splint


Open reduction
Indications
 Unfavorable fracture at angle of the
mandible
 Severely displaced fractures
 Bilateral condyle
midface fractures

fractures

 Where treatment is delayed
 Non-united fractures
 Rigid fixation to be used

with

Management:Methods of fixation used with open
reduction
 Trans osseous wiring
 Compression plates
 Non compression plates
 Lag screws

Compression Plates
 Advantages: Anatomic reduction
 Fracture fragments compression
 Rigid immobilization


Alveolar fractures
Immobilization Methods
Cold curing acrylic splint
 Composite resin splint
 Arch bar
 Figure of eight wiring
 Loop wiring
 Metal splint

Thank you
Leader in continuing dental education


Mandibular fractures / fixed orthodontic courses

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