Oral and maxillofacial surgery

سامي. محمد سهى د

والفكين والوجه الفم جراحة ماجستير

الفم إمراض تشخيص دبلوموالفكين والوجه الفم جراحة في ممارسMandibular Fracture

Classification: It has divided into different categories according

to the preference of operator or authors generally speaking # mand are classication according to the following:

1.According to type of.# 2.According to site of.#

3.According to cause of.#

Mandibular Fracture

The mandible represent the Lower 1/3 of the face.

the mand. is a thick bone but it is still have more incidence of # (fracture) than the middle 1/3 bones

although they are much thinner .

Most of research gives the incidence of # mand. in the a noticed ratio between # mand & middle 1/3.

A) Simple# .

is a linear # with little or no displacement. it is not connected to the outside environment.

green stick # → which is seen in children may be considered under heading of simple.#

B) compound# . # which is connected to outside environment.

for this reason any # involved the tooth bearing area of mandible is considered to be compound#

due to the fact that it is connected to the P.D. membrane. & ligament.

C) Cominuted# . which is caused by more sever trauma resulting

in sever # lines connected to each other resulting in divided the bone into several pieces.

D) Pathological# . # which is caused by presence of disease or

lesion in the bone caused by simple force.

Some time force of mastication may cause # ex. of such type of # is osteomylatis of jaw or presence of cyst or pathological lesion inside the bone which weakness the mandible.

– According to site of:# – Different site of mandible are liable to # & these are

in consequence:

1.Dento alveolar# . 2.Condylar & condylar neck.#

3.Angle of Mand.# . 4.Body of Mand.# .

5.Symphesis & parasymphesis region .# 6.Ramus.#

7.Coronoid.#

Unilateral #: this occurs as a result of direct force # one or more than # line could be seen on the affected side.

Bilateral #: This a combination of direct & indirect force # s. usually occurs in the body or symphesis region on one side & condoylar neck, or angle of mandible on other side.

According to cause of:#

Also as a result of excessive muscular contraction & this occur in cases of coronoid process & according to direct & indirect force # mand. may be class. into the following:

1 .Unilateral #: this occurs as a result of direct force # one or more than # line could be seen on the

affected side._ 2.Bilateral #: This a combination of direct &

indirect force # s. usually occurs in the body or symphesis region on one side & condoylar neck, or angle of mandible on other side.

3.multiple:# this # in which we have # of symphesis region with bilateral

# lines on both sides of mand. involving condylar or condylar neck . or angle of mand .

4 .comminuted #: this # in which may be cause byhigh velocity messile or sharpness which part of mand may be lost with part of soft. tissue overlying it is also lost & the

# presented with multiple # lines .

Surgical anatomy Muscular attachment Generally speaking any #

with out tearing of periostum will not result in displacement of # line as a result of muscle action.

displace of fragment only result when there is

tearing in periostum & this is a fact.

In order to under stand the action of Ms. in diff. part of mand .

we have to differentiate diff. sites: Angle of mandible The angle of mand

controlled by 2 thick ms. i.e the medial ptrygoid m. & masseter m. & they act

as muscular sling arround angle of mand. med. ptry. ms has stronger ms. pull than the masseter m .

according to the displacement the # line are class. or divided into-:

A.favourable # line. B.infavourable # line.

Symphesis Region : this region is controlled by mylohyoid & genohyoid

m . 1 .The # line in the middle of symph. region or in the

mand. result in stable # as a result of stabilization of ms. Pull .

2 .In oblique # in this region result in inward displacement.

3 .Bilateral # of symph. region in unconscious pat. may result in backward displace of symph. region as a result of

genioglossus ms ,.

Condyle: the condyle is affected by lateral ptry. ms. & this is may result in medial or inward displace of the condyle.

Fracture of the ramus is usually sandwitched between musseter & med. pte. ms. & the make the possibility of displacement of # is less liable.

Edentulous pat. : as a result of teeth extraction or is resorption of alveolar bone & for this reason the mylohyoid m. will be relatively speaking higher in position than when the teeth are present.

this may weaken the jaw a trauma applied to the mand. usually cause bilateral # of symph & parasymph region

with outward & downward displace .

Clinical presentation:

1 .Bleeding will result & come out the ear this is v. important & you must make sure that bleeding from skin & external auditory meatus & not from middle auditory meatus as # of base of skull with auto

cerebro-spinal-fluid (CSF) leakage.

2 # .the blood may tracked itself between mastoid bone & post. part of ramus resulting in heamatoma formation at the back or below the ear, the should be again distinguished from # in base of skull which have

the same clinical presentation & called (battle sign) .

3 .on the unaffected side you feel movement of condoylar, where as in the affected side the mov. may

be missing or not as noticible as of unaff .

4 .Deviation of midline.

5 .Gaging of post.–teeth on the epsilateral teeth or side open bite on contralatrtal .

6.There is pain & limitation in jaw movement &

tender to palpation with cripitation sound in certain cases may be heared or felled.

Treatment of # mandible. Emergency treatment:

deals with breathing problem & bleeding problem, which is similar to the life saving measure disscused

in middle 1/3.# Definet treatment: The principle of treatment of any

# of any bone is as follows: Reduction

Fixation Immobilization

1-Reduction:

is to reduce space between 2 fragment of #s & we have 2 types of reduction either open reduction

close reduction.

2 .Fixation: Acheif by using one of the following methods:

By using the tooth as means of fix or direct fix on bone several methods & instrument are used for this method either by wiring & this include direct wiring or by using eyelit wiring.

Direct wiring by bone:

by wiring & this include direct wiring or by using eyelit wiring.

Using of arch bar: We have diff.

types of arch bars the most famous AB. is the Jelenko AB. & Erich which is more flexible AB & we apply the wire on upper & lower & tie it together.

By use miniplate osteosynthesis.

For Immobilization: We use I.M.F. in which the mandible connect to the

maxilla teeth by tie wire.