Maxillofacial trauma is a major cause of mortality and morbidity worldwide. It is a frequent occurrence in Pakistan and is associated with high incidence of facial fractures in different combinations. Mandibular fractures are one of the most common facial fractures.1-6 Some of the most severe injuries are caused by automobile accidents but many others result from interpersonal violence, industrial accidents, sports, home accidents and missiles or gun shots.7 Road traffic accidents (RTA) have been reported as a leading cause of mandible fractures in many third world countries while interpersonal altercations are mainly responsible in the developed countries.8-10 The differences reflect a lack of traffic regulations including seat belt and helmet enforcements, absence of air bags in the vehicles and poor road infrastructure in the underdeveloped and alcohol abuse in the developed countries.11-13 Countries where the use of seat belt and safety helmet regulations have been made compulsory showed a decrease trend of mandibular fractures associated with RTA as compared to the past.14,15 Mandible fractures overwhelmingly occur in young males.3,16-18 Although there is a universal agreement as to the treatment goals and basic therapeutic principles of reduction and stabilization, a variety of currently accepted treatment modalities indicate a lack of consensus.

1. MANAGEMENT OF
MAXILLOFACIAL TRAUMA
PRESENTED BY:
S.NAGARAJAN,
RAGAS DENTAL COLLEGE.

2. SYNOPSIS
 INTRODUCTION
 PRINCIPLES OF FRACTURE REPAIR
 REDUCTION
 CLOSED
 OPEN
 FIXATION
 INDIRECT FIXATION
 DIRECT FIXATION
 IMMOBILIZATION
 EARLY RETURN OF FUNCTION
 CONCLUSION

3. REDUCTION
CLOSED
ROWES
HAYTON
WALSHAM
ASCH
OPEN

4. REDUCTION
CLOSED
ROWES
HAYTON
WALSHAM
ASCH
OPEN

5. REDUCTION
CLOSED
ROWES
HAYTON
WALSHAM
ASCH
OPEN

6. REDUCTION
CLOSED
ROWES
HAYTON
WALSHAM
ASCH
OPEN

7. REDUCTION
CLOSED
ROWES
HAYTON
WALSHAM
ASCH
OPEN

8. REDUCTION
CLOSED
ROWES
HAYTON
WALSHAM
ASCH
OPEN

9. FIXATION
CLOSED FIXATION
IMF OR MMF
DENTAL WIRING
ARCH BARS
CAP SPLINTS
BONDED MODIFIED ORTHODONTIC
BRACKETS
CIRCUMFERENTIAL WIRING
INTERMAXILLARY FIXATION SCREWS
SUSPENSIONS
CENTRAL
LATERAL
CIRCUMZYGOMATIC
ZYGOMA BUTRESS
INFRAORBITAL
PYRIFORM
EXTERNAL
FIXATION
PIN FIXATION
KIRCHNER WIRES
HALOFRAMES
INTERNAL
FIXATION
SEMI
RIGID
TRANOSSEOUS
WIRING
NONCOMPRESSI
ON MINIPLATES
RIGID
COMPRESSION
PLATES
LAG SCREWS
RECONSTRUCTION
PLATES

10. IMFORMMF
DENTAL WIRING
ARCH BARS
CAP SPLINTS
BONDED MODIFIED ORTHODONTIC
BRACKETS
CIRCUMFERENTIAL WIRING
INTERMAXILLARY FIXATION SCREWS

11. IMFORMMF
DENTAL WIRING
ARCH BARS
CAP SPLINTS
BONDED MODIFIED ORTHODONTIC BRACKETS
CIRCUMFERENTIAL WIRING
INTERMAXILLARY FIXATION SCREWS
DIRECT INTERDENTAL WIRING
EYELET
BRIDDLES
WIRING

12. IMFORMMF
DENTAL WIRING
ARCH BARS
CAP SPLINTS
BONDED MODIFIED ORTHODONTIC BRACKETS
CIRCUMFERENTIAL WIRING
INTERMAXILLARY FIXATION SCREWS
ERICKS
WINTERS
JELENKOS
KILLEY AND KAY RULE:
THREE WEEKS
 Tooth retained in fracture line:
add 1 week
 Fracture in symphisis:
add 1 week
 Age 40 yrs. and above:
add 1 week
 Children and adolescents:
subtract 1 week

13. IMFORMMF
DENTAL WIRING
ARCH BARS
CAP SPLINTS
BONDED MODIFIED ORTHODONTIC BRACKETS
CIRCUMFERENTIAL WIRING
INTERMAXILLARY FIXATION SCREWS

14. IMFORMMF
DENTAL WIRING
ARCH BARS
CAP SPLINTS
BONDED MODIFIED
ORTHODONTIC
BRACKETS
CIRCUMFERENTIAL WIRING
INTERMAXILLARY FIXATION SCREWS

15. IMFORMMF
DENTAL WIRING
ARCH BARS
CAP SPLINTS
BONDED MODIFIED ORTHODONTIC BRACKETS
CIRCUMFERENTIAL
WIRING
INTERMAXILLARY FIXATION SCREWS

16. IMFORMMF
DENTAL WIRING
ARCH BARS
CAP SPLINTS
BONDED MODIFIED ORTHODONTIC
BRACKETS
CIRCUMFERENTIAL WIRING
INTERMAXILLARY
FIXATION SCREWS

17. SUSPENSIONS
CENTRAL
LATERAL
CIRCUMZYGOMATIC
ZYGOMA BUTRESS
INFRAORBITAL
PYRIFORM

18. EXTERNAL
FIXATION
KIRCHNER WIRES
HALOFRAMES
BOX FRAME

19. EXTERNALFIXATION
KIRCHNER WIRES
HALOFRAMES
BOX FRAME

20. EXTERNALFIXATION
KIRCHNER WIRES
HALOFRAMES
BOX FRAME
 For supraorbital
ridge fractures
 Has circular frame
attached to skull
by four pins
 Disadvantage:
discomfort

21. EXTERNALFIXATION
KIRCHNER WIRES
HALOFRAMES
BOX FRAME
 Has two
supraorbital pins
and two
mandibular pins
 Each are
connected by
rods and joints

22. DIRECTFIXATION SEMI
RIGID
TRANOSSEOUS
WIRING
NONCOMPRESSION
MINIPLATES
RIGID
COMPRESSION
PLATES
LAG SCREWS

23. DIRECTFIXATION
SEMI
RIGID
TRANOSEOUS
WIRING
NONCOMPRESSION
MINIPLATES
RIGID
COMPRESSION PLATES
LAG SCREWS

24. DIRECTFIXATION
SEMI
RIGID
TRANOSSEOUS
WIRING
NONCOMPRES
SION
MINIPLATE
RIGID
COMPRESSION
PLATES
LAG SCREWS

25. DIRECTFIXATION
SEMI
RIGID
TRANOSSEOUS
WIRING
NONCOMPRES
SION
MINIPLATE
RIGID
COMPRESSION
PLATES
LAG SCREWS

26. DIRECTFIXATION
SEMI
RIGID
TRANOSSEOUS WIRING
NONCOMPRESSION
MINIPLATES
RIGID
COMPRESSION PLATES
LAG SCREWS

27. COMPRESSION PLATE

28. PRIMARY LOSS OF REDUCTION IN NON COMPRESSION PLATES

29. SECONDARY LOSS OF REDUCTION IN NON COMPRESSION PLATES

30. NON COMPRESSION MINIPLATES COMPRESSION PLATES
Most widely used in maxillofacial
trauma(mandibe..)
Widely in long bone fracture
management (femur…)
Its semi rigid It is rigid
Plates has to be adapted to bone surface
or else 1°loss of reduction will happen
No need for adaptation
Has to be placed in neutral zone or else
2°loss of retention will happen
Less chance of loss of reduction bcoz
screws are locked
IMF is needed IMF not needed
Periosteal blood supply is compromised It is preserved

32. LAG SCREWS
CORTEX
CORTEX
MEDULLA

33. DRILLING SCREW PERPENDICULAR TO FRACTURE LINE

34. DRILLING SCREW NOT PERPENDICULAR TO FRACTURE LINE