GOOD AFTERNOON NARENDRA SIR AND MY DEAR CLASSMATES TODAY I

SIDHARTH PANDEY AM HERE TO PRESENT THE SEMINAR ON TOPIC FACTRUE

AND ITS MANAGEMENT IN MANDIBLE.
IN THIS SEMINAR WE WILL BE DISCUSSING THE FOLLOWING TOPICS….
LIKE INTRODUCTION AND
CLASSIFIVATIONS,AETIOLOGY,EPIDEMIOLOGY,SIGNS&
SYMPTOMS,INVESTIGATION OF THE FRACTURE AND ALSO ITS MANAGEMENT
AND COMPLICATION.

INTRODUCTION Fracture of the mandible occurs more frequently than

that of any other facial skeleton.

It is the one serious facial bone injury that the average practicing dental
surgeon may expect to encounter, albeit on rare occasions, at his
surgery.

It is also a facial fracture which he may have the misfortune to cause as

a complication of tooth extraction.

Broadly divided into:

1. Fractures with no gross communition of the bone and without

significant loss of hard and soft tissues

2. Fractures with gross communition of

the bone and with extensive loss of both hard and soft tissues.

ANATOMY
• Lower jaw bone

• U shaped body
2 vertically directed rami
Condylar process
Coronoid process
Oblique line

• Mental foramen

INTERNAL ANATOMY
. Mandibular foramen

• Lingula

. Pterygoid fovea

• Mylohyoid line

Fossae

Submandibular

• Sublingual Digastric

• Mental spines

Genioglossus

Geniohyoid

MUSCULATURE: jaw elevators

• Masseter muscle: from zygoma to angle and ramus

• Temporalis muscle: from infratemporal fossa to coronoid and ramus.

• Medial pterygoid muscle: medial pterygoid plate and pyramidal process

into the lower mandible.

MUSCULATURE: jaw depressors

• Lateral pterygoid muscle: lateral pterygoid plate to condylar neck and

TMJ capsule

Mylohyoid muscle: Mylohyoid line to body of hyoid

Digastric muscle: mastoid

notch to digastric fossa

Geniohyoid muscle: inferior genial tubercle to anterior hyoid bone

INNERVATION

CN3; mandibular nerve through the foramen ovale

Inferior alveolar nerve through the mandibular foramen

Inferior dental plexus

• Mental nerve through the mental foramen.

CLASSIFICATION OF FRACTURES

Type of fracture

• Site of fracture

• Cause of fracture

TYPE OF FRACTURE

• Simple

• Includes a closed linear fractures of the condyle, coronoid, ramus and

edentulous body of the mandible.

• Compound

Fractures of tooth bearing portions of the mandible, into d mouth via the
periodontal membrane and at times through the overlying skin.
• Communited

Usually compound fractures characterized by fragmentation of bone

Pathological

Results from an already weakened mandible by pathological conditions.

EPIDEMIOLOGY

• The mandible is one of the most commonly fractured bones of the face
and this is directly related to its prominent and exposed position.

• Oikarinen and Lindqvist (1975) studied 729 patients with multiple

injuries sustained in RTA. The most common facial fractures were in the
mandible.

• Mandible (61%)

• Maxilla (46%)

Zygoma (27%)

• Nasal Bone (19%)

• Studies have shown that the incidence of mandible fractures are

influenced by various etiological factors e.g.

Geography

Social trends

Road traffic legislations

•Seasons
SPECIFIC SIGNS AND SYMPTOMS

.. DENTOALVEOLAR FRACTURES

Lip bruises and laceration

Step deformity

Bony discontinuity

Fracture, luxation or subluxation of teeth

Laceration of the gingivae

• FRACTURE OF THE BODY

Swelling

• pain

• Tenderness
Step deformity

• Anaesthesia or paraesthesia of the lip

• Intra oral hemorrhage

SYMPHYSEAL/PARASYMPHYSEAL FRACTURES

Tenderness

Sublingual haematoma

• Loss of tongue control

• soft tissue injury to the chin and lower lip

FRACTURE OF THE RAMUS

Swelling
Ecchymosis

Pain

. Trismus

FRACTURE OF THE ANGLE

Swelling

• Posterior gag

Deranged occlusion

Anaesthesia or paraesthesia of lower lip

• Hematoma

Step deformity behind the last molar tooth

Tenderness
CORONOID FRACTURE

Tenderness over the anterior part of the tragus

Haematoma

. Painful limitation of movement

• Protrusion of mandible may be present.

The treatment plan for mandibular fractures is dependent on precise

radiological diagnosis.
The radiological diagnosis is done through radiographs.

The radiographs are divided in two main categories: Essential

radiographs and desirable radiographs

Essential radiographs are the further divided into two sub categories
such as Extra Oral and Intra oral radiographs

Treatment plan for mandibular fractures is very dependent on precise

radiological diagnosis

RADIOGRAPHS

Essential radiographs

Extra-oral radiographs

• Intra-oral radiographs

• Desirable radiographs

MANAGEMENT

Airway

Tongue falling back

Blood clots

• Fractured teeth segments

Broken fillings

• Dentures

Hemorrhage
Soft tissue lacerations

• Support of bone fragments .

Pain control

• Infection control e.g. compound fractures

Food and Fluid

DEFINITIVE TREATMENT

• Reduction

• Restoration of a functional alignment of the bone fragments

• Use of occlusion
1. Open reduction

2. Closed reduction

Immobilization

• To allow bone healing

Through fixation of fracture line

1. Rigid
2. Non-rigid

BONE HEALING

• Bone healing is altered by types of fixation and mobility of the fracture

site in relation to function

Primary bone healinG

• Secondary bone healing

Primary bone healing:

No fracture callus forms

Heals by a process of

1. Haversia remodeling directly across the fracture site if no gap exists

(Contact healing), or

2. Deposition of lamellar bone if small gaps exist (Gap healing)

Requires absolute rigid fixation with minimal gaps

Secondary bone healing:

Bony callus forms across fracture site to aid in stability and

immobilization

• Occurs when there is mobility around the fracture site

Secondary bone healing involves the formation of a sub periosteal

hematoma, granulation tissue, then a thin layer of bone forms by
membranous ossification. Hyaline cartilage is deposited, replaced by
woven bone and remodels into mature lamellar bone
TEETH IN LINE OF FRACTURE
• Teeth in line of fracture are a potential impediment to healing for the
following reasons

1. The fracture is compound into the mouth via the opened periodontal
membrane

2. The tooth may be damaged structurally or loose its blood supply as a

result of the trauma so that the pulp subsequently becomes necrotic

3. The tooth may be affected by some pre-existing pathological process

Indications for removal

• Absolute

• Relative

Absolute indications

Longitudinal fracture involving the root

• Dislocation or subluxation of tooth from socket

•Presence of periapical infection

Infected fracture line

Acute pericoronitis

Relative indications
• Functionless tooth which would eventually be removed electively
• Advanced caries

• Advanced periodontal disease

• Teeth involved in untreated fractures presenting more than 3days after

injury

IMMOBILIZATION

The period of stable fixation required to ensure full restoration of function

varies according to:

1. Site of fracture

2. Presence of retained teeth in the line of fracture

3. Age of the patient

4. Presence or absence of infection