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Mandibular fracture

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lecture for fifth stage students of dentistry college

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Mandibular fracture

  1. 1. Mandibular fracture Dr.Mohamed Rahil Tikrit dentistry college
  2. 2. Mandibular anatomy
  3. 3. Mandibular anatomy
  4. 4. Mandibular anatomy • Blunt V -shape • Midline srongest part • Its movment occur in relation to base of skull • Although anatomically the condyles are the articular surfaces of the mandible ,but functionally the occlusal surface of the mandibular teeth observes this role
  5. 5. • Strong bone , great energy required to fracture it (44.6 -74.4 kg/ m) • But its more commonly to fracture than other bones of face because : • A. its prominent • B.blows to mandible transmitted to base of skull unlike midface which absorbs direct trauma • C. lines of relative weakness (long canine ,wisdom teeth, alveolar resorption …..)
  6. 6. classification I. According to the nature of injury a. Civillian type fracture b. Gunshot –type fracture
  7. 7. II . According to type of fracture a.Simple fracture b.Compound fracture c.Comminuted fracture
  8. 8. II . According to type of fracture a.Simple fracture b.Compound fracture c.Comminuted fracture d.Pathological fracture e.Complicated fracture f.Impacted fracture g.Green stick fracture
  9. 9. III. According to the site of fracture A. dento-alveolar fracture B. Condyle C. Coronoid D. Ramus E. Angle F. Body G. Symphysis H. parasymphysis
  10. 10. According to the cause of fracture • Direct violence • Indirect violence • Excessive muscle contraction
  11. 11. V. According to the treatment pattern • Unilateral • Bilateral • Multiple • Comminuted
  12. 12. Clinical examination • General examination of the patient • Local examination of the mandible
  13. 13. Tooth in fracture line • It affect on healing of fracture due to : 1. Fracture compound into the mouth via periodontal membrane 2. Blood supply to the tooth may damaged causing pulp necrosis and infection 3. Pre-existing pathological lesions
  14. 14. Indications for removal of a tooth in fracture line Absolute indications a. Longitudinal fracture of tooth involving the root b. Subluxation of the tooth from its socket c. Presence of periapical infection d. Infected fracture line e. Acute pericoronotis Relative indications : a. Functionless tooth b. Advanced caries c. Advanced periodontal disease
  15. 15. Signs and symptoms of mandibular fractures
  16. 16. Dentoalveolar fracture
  17. 17. Condylar fracture
  18. 18. Condylar fracture
  19. 19. Elastic traction
  20. 20. Coronoid process fracure
  21. 21. Coronoid process fracure
  22. 22. Angle fracture
  23. 23. Symphysial fracture
  24. 24. Parasymphysial fracture
  25. 25. Parasymphysial fracture
  26. 26. Radiographical examination
  27. 27. 1. Intra oral radiograph a. Periapical b. Occlusal and oblique occlusal 2. extra-oral radiograph Oblique lateral Postero-anterior Opg Reverse town view TMJ view CT scan MRI
  28. 28. OPG
  29. 29. True lateral
  30. 30. Oblique lateral
  31. 31. Postereo-anterior
  32. 32. Coronal view CT scan
  33. 33. Axial view CT scan
  34. 34. 3D Reconstruction CT scan
  35. 35. Definitive treatment • Reduction • Fixation • Immobilization • Follow up and rehabilitation
  36. 36. Reduction • Closed reduction • Open reduction
  37. 37. Fixation and immobilization 1. Dental wiring a. Direct wiring b. Eyelet wiring
  38. 38. Fixation and immobilization 1. Dental wiring a. Direct wiring b. Eyelet wiring 2. Arch bar
  39. 39. Fixation and immobilization 1. Dental wiring a. Direct wiring b. Eyelet wiring 2. Arch bar 3. Cap splint
  40. 40. Fixation and immobilization 1. Dental wiring a. Direct wiring b. Eyelet wiring 2. Arch bar 3. Cap splint 4. Gunning type splint
  41. 41. Fixation and immobilization 1. Dental wiring a. Direct wiring b. Eyelet wiring 2. Arch bar 3. Cap splint 4. Gunning type splint 5. Transosseous wiring
  42. 42. Fixation and immobilization 1. Dental wiring a. Direct wiring b. Eyelet wiring 2. Arch bar 3. Cap splint 4. Gunning type splint 5. Transosseous wiring 6. Bone plating
  43. 43. Fixation and immobilization 1. Dental wiring a. Direct wiring b. Eyelet wiring 2. Arch bar 3. Cap splint 4. Gunning type splint 6. Bone plating 7. Transosseous wiring 8. k-wire 9. Extra oral pin fixation
  44. 44. Follow up and rehabilitation 1. Immediate post operative phase 2. Intermediate post operative phase 2-4 weeks 3. Late postoperative phase from 4th -6th weeks
  45. 45. Complications of mandibular fracture 1. Parasthesia 2. Scar 3. Occlusal derrangment 4. Ankylosis 5. Mal-union ,non union 6. Pyogenic infection 7. Traumatic myositis ossificans of the masseter muscle
  46. 46. Thank you for listening

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