Ahmed Zebari & Zuhair Zain

8/13/2019 Ahmed Zebari & Zuhair Zain

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Treatment Planning &Seminars

Case Presentation

Ahmed Amer Zebari 200910256

Zuhair AlZain 200911234


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* 79 Years old man, full denture user with

long standing controlled hypertensionsustained a fall on floor in toilet. He was

presented with pain while talking & inability

to open mouth wide.


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DIAGNOSIS OF FRACTURED

MANDIBLES

* History

(Past Medical History, Type and Direction

of Traumatic Force)

* Clinical Examination(extraoral &intraoral ecchymosis, Swelling,

pain and tenderness to palpation, etc)

* Radiographic Examination(OPG), mandible series radiograph and CT

scans can be used to diagnose and plan the

treatment


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Diagnostic Imaging:

The facial radiographic examination should depend to

some degree on the clinical examination and thesuspected injury.

The purpose of radiographs is to confirm thesuspected

clinical diagnosis & determine the extent of the injury.

Radiographic evaluation of the mandible requires two or

more of the following radiographic views :

- Panoramic view.

- Posterior Anterior View.

- Lateral Oblique view.

- CT scan.

- Towne's view.


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- PA view : Body Fracture - LO view: Angle Area Fracture


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- Towns View: Dis. Of Cond. Fracture. - Panoramic View: Dis. Fracture of body &

Subcondylar fracture


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Treatment Of Condyle:

- Some patients can be treated with a liquid to softdiet and careful follow-up evaluation.

- If malocclusion is present after periarticular edema

resolves, closed reduction is performed.

- Non-operative management of condylar fractures

can be used more liberally for edentulous patients,

who can tolerate moderate degrees of condylar

displacement. New dentures can compensate forthe change

in jaw relations.


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Treatment Options Of Condylar Fractures:1- No Treatment.

2- Closed Reduction.

3- Open Reduction.

4- Endoscopically Assisted.


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Treatment Options Of Condylar Fractures:1 - No Treatment:

No treatment is considered when no occlusal discrepancy or

Functional impairment exists.

2- Closed Reduction:

- Very high condylar neck fractures without dislocation.

- Intra-capsular Fractures.

Patient.Elderly-


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- Endoscopically Assisted:

_ It reduces the risk to the facial nerve and minimize

scaring.

_ Using intraoral approach, a Ramus incision is made

and the masseter muscle stripped to create the optical

cavity.

_ Under vision and with special instruments the fracture

is manipulated and reduced.


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Fractures of Edentulous Mandible:

- Resorption.- Aging process & bone structure.

- Cross-Sectional area.

- Type of Fracture.

- Trismus is a relatively

constant finding with

mandibular fractures.


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Atrophic edentulous Mandible mostly

fracture at the midbody, where the

atrophy is most advanced.


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Control Of Pain:

- If present : Give adequate

analgesia. ( Avoid giving

powerful analgesics, which

depress the level of

consciousness & respiration.

-


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Treatment for edentulous mandibular

fracture:

Methods of immobolization :

1- Indirect Skeletal Fixation: Gunning-type

splint.

2- Direct Skeletal Fixation :

A- Extra Oral Pin Fixation

B- Transosseos wiring.

C- Bone plating.


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Ahmed Zebari & Zuhair Zain