lecture for fifth stage students of dentistry college

1. Mandibular fracture
Dr.Mohamed Rahil
Tikrit dentistry college

2. Mandibular anatomy

3. Mandibular anatomy

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

6. • 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 …..)

7. classification
I. According to the nature of injury
a. Civillian type fracture
b. Gunshot –type fracture

8. II . According to type of fracture
a.Simple fracture
b.Compound fracture
c.Comminuted fracture

9. 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

10. 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

11. According to the cause of fracture
• Direct violence
• Indirect violence
• Excessive muscle
contraction

12. V. According to the treatment pattern
• Unilateral
• Bilateral
• Multiple
• Comminuted

13. Clinical examination
• General examination of the patient
• Local examination of the mandible

14. 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

15. 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

16. Signs and symptoms of mandibular
fractures

17. Dentoalveolar fracture

18. Condylar fracture

19. Condylar fracture

20. Elastic traction

21. Coronoid process fracure

22. Coronoid process fracure

23. Angle fracture

24. Symphysial fracture

25. Parasymphysial fracture

26. Parasymphysial fracture

27. Radiographical examination

28. 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

29. OPG

31. True lateral

32. Oblique lateral

33. Postereo-anterior

36. Coronal view CT scan

37. Axial view CT scan

38. 3D Reconstruction CT scan

39. Definitive treatment
• Reduction
• Fixation
• Immobilization
• Follow up and rehabilitation

40. Reduction
• Closed reduction
• Open reduction

41. Fixation and immobilization
1. Dental wiring
a. Direct wiring
b. Eyelet wiring

43. Fixation and immobilization
1. Dental wiring
a. Direct wiring
b. Eyelet wiring
2. Arch bar

44. Fixation and immobilization
1. Dental wiring
a. Direct wiring
b. Eyelet wiring
2. Arch bar
3. Cap splint

45. Fixation and immobilization
1. Dental wiring
a. Direct wiring
b. Eyelet wiring
2. Arch bar
3. Cap splint
4. Gunning type splint

46. 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

47. 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

48. 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

50. 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

51. 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

52. Thank you for listening