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Mandibular Fractures
Mandibular Fractures
Mandibular Fractures
Relative Indications
1. Anterior and medial displacement of the condylar
fragment.
2. Unilateral or bilateral fractures with loss of the
posterior teeth
3. Cases in which position of the condylar fragment
interferes with normal function of the jaws.
Dentoalveolar fracture
Type I: Fractures within enamel
Type II: Fractures involving enamel
and dentin
Type III: Fractures involving pulp
Type IV: Root fractures
Assessment
The mechanism of injury and time of occurrence, as
well as witnessed accounts should be recorded.
Mechanism of injury will provide
information about any potential foreign
bodies that need to be removed or
contaminants that may affect wound
healing.
Physical examination includes inspection
of the area noting the location, size, and
shape of the wound. Limitation of function
and involvement of nerves, vessels, muscles.
Presence of foreign bodies, contamination,
associated fractures or hematomas.
Timing of repair
Tissue adhesive
Cyanoacrylate-based tissue adhesives have been
used for laceration repair
Postoperative care
Postoperative wound care should
include verbal and written instructions
and information about the dressing
management, cleansing of the wound,
activity limitations, pain management,
expectations of the appearance of the
wound during the healing course, and
follow-up appointment.
Dressing management
Repaired lacerations of the face can generally
be left uncovered. Due to the high vascularity
of facial skin, these wounds usually heal well
and have a low risk of infection. The use of
white petrolatum ointment may be just as
effective at preventing crusting around the
wound encouraging epithelialization to occur
rapidly and allowing easy removal of sutures
Abrasion
Abrasions are typically characterized as
superficial injuries that denude the surface
epithelium; however, involvement of deeper
cutaneous layers must be ruled out. Serve as
massive portals of entry for microbes, much
like burn injuries. proper management is
required to prevent poor outcomes such as
infection, scarring, or contamination tattooing.
Abrasions require thorough lavage with irrigant
along with careful inspection and removal of any
solid remnants and necrotic epithelium. Remaining
irritants may be the source of prolonged
inflammation, infection, and eventual discoloration
of the wound following healing.
Abrasions are generally more painful than
lacerations or puncture wounds and more
aggressive forms of pain management should be
considered.
Abrasive wounds should be dressed with
antibiotic ointment and covered with
sterile gauze if necessary to maintain
wound moisture until re-epithelialization
is complete and final resolution of
the wound takes place.
Laceration
Laceration is the most common type of facial injury
requiring surgical intervention. Assessment
of the depth of injury and reapproximation of
transected tissues is undertaken prior to closure of
the skin. Irregular edges and devitalized tissues
should be excised to provide sharp edges for easier
reapproximation when cosmetically possible.
Closure should be undertaken in
multiple layers with absorbable
sutures used for deep layers, and the
skin closed with monofilament
sutures which should be removed
after 3–5 days.
Contusions and haematomas
Bruising injury resulting from trauma is often
associated with tissue oedema. These injuries are
often associated with haematoma, which, if small, is
resorbed by the body. A moist, heated compress may
aid in reabsorption. Larger haematomas may be
selectively incised and drained to prevent
subcutaneous scarring.
Avulsion
When small areas of tissue are lost due
to trauma, undermining the adjacent skin
will allow the margins to be directly
approximated and closed. Larger defects,
however, will require skin grafts or flaps
for coverage.
Mucosa
In general, lacerations, abrasions, and
burns of the mucosa heal quickly with
little intervention needed; however, if
large or gaping, intraoral wounds
benefit from approximation and suture
closure
Bites
Human and animal bites result in
extensively contaminated wounds.
Copious irrigation and sharp
debridement of devitalized tissue is
essential in preventing wound infection.
This may result in sacrifice of vital soft
tissue components in aesthetically
sensitive areas, but cannot be avoided.
Quiz