Mandibular Fractures Overview
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Questions and Answers

What characterizes closed treatment of mandibular fractures?

  • Is only suitable for adult patients
  • Requires surgical exposure of the fracture site
  • Involves manipulation or elastic traction (correct)
  • Provides immediate anatomical reduction

    • Which of the following is NOT an indication for closed treatment of mandibular fractures?

  • Medically compromised patients
  • Non-displaced favorable fractures
  • Pediatric fractures with mixed dentition phase
  • Severe compound fractures (correct)

    • Which immobilization method utilizes bonded orthodontic brackets?

  • Interdental wiring
  • Indirect fixation
  • Intermaxillary fixation (IMF) (correct)
  • Elastic bands

    • What is a major disadvantage of closed treatment for mandibular fractures?

    <p>Does not ensure anatomical reduction</p> Signup and view all the answers

    Which patient condition is contraindicated for closed treatment?

    <p>Epilepsy</p> Signup and view all the answers

    What is one advantage of closed treatment?

    <p>Non-invasive and simpler to perform</p> Signup and view all the answers

    What method is only applicable when the patient has a complete number of teeth?

    <p>Interdental wiring</p> Signup and view all the answers

    Which of the following statements is true regarding closed treatment?

    <p>It can be definitive or temporary stabilization.</p> Signup and view all the answers

    What is the main treatment method for mandibular fractures?

    <p>Open reduction and internal fixation (ORIF)</p> Signup and view all the answers

    Which of the following is NOT an indication for open treatment of mandibular fractures?

    <p>Fractures of a well-aligned mandible</p> Signup and view all the answers

    What is the characteristic of miniplates in the treatment of mandibular fractures?

    <p>Offer semi-rigid or load sharing fixation</p> Signup and view all the answers

    Which surgical approach is NOT mentioned for the treatment of mandibular fractures?

    <p>Laparoscopic access</p> Signup and view all the answers

    Non-compression rigid plates are primarily used in which situations?

    <p>Infected and severely comminuted fractures</p> Signup and view all the answers

    What fixation method is considered a non-rigid fixation method?

    <p>Interosseous or Transosseous wiring</p> Signup and view all the answers

    Which type of screw is used to anchor the miniplates in mandibular fracture treatment?

    <p>Monocortical screws</p> Signup and view all the answers

    What is the significance of the quadrangle principle in three-dimensional titanium miniplates?

    <p>It ensures a geometrically stable configuration for support</p> Signup and view all the answers

    What is the definition of a fracture?

    <p>A break in the continuity of the bone due to violence or insufficient health.</p> Signup and view all the answers

    Which type of mandibular fracture does not communicate with the external environment?

    <p>Simple fracture</p> Signup and view all the answers

    What is a characteristic feature of a comminuted fracture?

    <p>Multiple fragments of bone</p> Signup and view all the answers

    Which of the following classifications of mandibular fractures occurs exclusively in children?

    <p>Greenstick</p> Signup and view all the answers

    Which classification pertains to fractures that extend into the external environment?

    <p>Compound fractures</p> Signup and view all the answers

    What does the term 'favorability' refer to in mandibular fractures?

    <p>The tendency of muscle pull to displace fracture fragments.</p> Signup and view all the answers

    How are mandibular fractures classified according to their anatomic site?

    <p>Based on the location, such as condylar or ramus.</p> Signup and view all the answers

    What is an example of a pathologic fracture?

    <p>A fracture from minimal trauma due to bone disease</p> Signup and view all the answers

    What is the primary concern regarding misplaced fixation devices in mandibular fractures?

    <p>Damage to the inferior alveolar canal</p> Signup and view all the answers

    Which factor does NOT contribute to the risk of infection at the fracture site?

    <p>Excessive immobilization techniques</p> Signup and view all the answers

    Which complication is most commonly associated with fractures of the body of the mandible?

    <p>Anesthesia or paresthesia of the lower lip</p> Signup and view all the answers

    The most effective way to prevent infection in a fracture site is by:

    <p>Ensuring proper antibiotic prophylaxis</p> Signup and view all the answers

    What is malunion in the context of mandibular fractures?

    <p>Healing of the fracture in an abnormal position</p> Signup and view all the answers

    What action should be taken if malalignment is noticed early after surgery?

    <p>Return the patient for repeated reduction</p> Signup and view all the answers

    Which of the following statements is true regarding the management of infections in mandibular fractures?

    <p>Controlling the infection requires both drainage and antibiotics</p> Signup and view all the answers

    Facial nerve damage primarily complicates fractures located in which area?

    <p>Ramus and condyle</p> Signup and view all the answers

    What typically occurs when a sequestrum extrudes into the mouth?

    <p>It may occur with minimal symptoms.</p> Signup and view all the answers

    Which factor is notable about mandibular fractures in children?

    <p>They often result in stable fractures within a week.</p> Signup and view all the answers

    What is a concern when managing mandibular fractures in children?

    <p>They may disturb developing teeth.</p> Signup and view all the answers

    What should be used for fixation in very young children with unerupted teeth?

    <p>An acrylic splint retained by circumandibular wires.</p> Signup and view all the answers

    What characterizes condylar fractures compared to other facial fractures?

    <p>They affect a synovial joint.</p> Signup and view all the answers

    What is recommended for treating intracapsular fractures in children?

    <p>Conservative treatment with early mobilization.</p> Signup and view all the answers

    What should be avoided during fixation of mandibular fractures to protect developing teeth?

    <p>Using plates or wire fixation on the upper border.</p> Signup and view all the answers

    Why might slight imperfections in fracture reduction be acceptable?

    <p>Because teeth will compensate for growth and eruption.</p> Signup and view all the answers

    Study Notes

    Mandibular Fractures

    • A break in the continuity of the bone, usually caused by violence or unhealthy bone.
    • Common due to the mandible's prominence, but require stronger impact forces than maxillary fractures.
    • Teeth play a crucial role in fracture location, with canine and wisdom teeth being weaker points.

    Mandibular Fracture Classification

    • By type:
      • Simple/Closed: Single fracture without external communication.
      • Compound/Opened: Extends into external environment via skin, mucosa, or periodontal membrane.
      • Comminuted: Multiple bone fragments, requiring significant energy.
      • Greenstick: One cortex broken, the other bent - found in children.
      • Pathologic: Caused by pre-existing bone disease leading to fracture from minimal trauma.
      • Complicated/Complex: Involves damage to vital structures impacting treatment and prognosis, often in severely atrophied mandibles.
      • Single: One fracture line.
      • Multiple: Two or more fracture lines that don't connect.
    • By anatomic site:
      • Dentoalveolar
      • Condylar
      • Coronoid
      • Ramus
      • Angle
      • Body (molar/premolar area)
      • Symphysis/Parasymphysis
    • By tendency to displace:
      • Favorable: Muscles pull fragments together, minimizing displacement.
      • Unfavorable: Muscles displace fragments significantly.

    Treatment of Mandibular Fractures

    • Closed Treatment:
      • Closed reduction with indirect fixation and immobilization using intermaxillary fixation (IMF) or mandibulomaxillary fixation (MMF).
      • Traditional conservative approach.
      • Uses manipulation, traction, and teeth alignment for stabilization.
      • Can be definitive or temporary before definitive open treatment.
      • Indications:
        • Non-displaced favorable fractures.
        • Limited resources for open treatment.
        • Medically compromised patients needing conservative treatment.
        • Grossly infected fractures.
        • Pediatric fractures with mixed dentition.
        • Edentulous fractures.
      • Advantages:
        • Non-invasive, simple, easy to master.
        • Perform under local anesthesia.
        • Less expensive.
      • Disadvantages:
        • Does not guarantee anatomical reduction.
        • Can be challenging with malocclusion, missing teeth, or damaged teeth.
        • Immobilization may not be adequate, delaying healing.
        • IMF negatively affects feeding and speech.
      • Contraindications:
        • Epilepsy, chronic respiratory diseases, non-compliant patients, alcohol or drug abuse.
    • Open Treatment:
      • Open reduction and internal fixation (ORIF) or direct skeletal fixation.
      • Surgical exposure and reduction, immobilizing fragments with internal fixation methods.
      • Primarily used for mandibular fractures.
      • Indications:
        • Displaced unfavorable fractures.
        • Multiple facial bone fractures.
        • Edentulous mandible fractures with severe displacement.
        • Delayed treatment with soft tissue interposition between fragments.
        • Systemic conditions contraindicating IMF.
      • Surgical approaches: Intraoral, extraoral, or combined.
      • Internal Fixation Methods (Osteosynthesis):
        • Interosseous or Transosseous wiring: Non-rigid fixation with wires through drilled bone holes.
        • Miniplates: Most common, semi-rigid fixation with plates anchored to outer cortical bone.
        • Three-dimensional titanium miniplates: Quadrangle-based, stable support secured with monocortical screws.
        • Non-compression rigid plates (Reconstruction plates): Rigid, load-bearing fixation used for infected, comminuted, or complex fractures.

    Mandibular Fracture Complications

    • Intraoperative and Early Postoperative:
      • Misplaced Fixation: Damage caused by misplaced wires or plates, potentially affecting the inferior alveolar canal and root apices.
      • Infection: Contributed by:
        • Compound fractures with contamination.
        • Inadequate stabilization.
        • Loose fixation devices.
        • Immunocompromised patients.
        • Can progress to cellulitis, abscess, fistula, osteomyelitis, and necrotizing fasciitis.
        • Prevention:
          • Antibiotic prophylaxis.
          • Wound hygiene.
          • Adequate immobilization.
          • Management of involved teeth.
          • Secure fixation devices.
        • Management:
          • Control infection (incision, drainage, antibiotics).
          • Remove infection source (teeth, sequestra, plates/screws).
          • Optimize healing environment.
          • Immobilize fracture.
      • Nerve Damage:
        • Anesthesia or paresthesia of the lower lip due to inferior alveolar nerve injury.
        • Can result from fracture or treatment, especially open treatment.
        • Facial nerve damage can occur with ramus and condyle fractures due to penetrating injury or blunt trauma.
    • Late Complications:
      • Malunion: Healing in an abnormal position due to inadequate reduction, immobilization, or lack of treatment.
      • Can lead to occlusal discrepancies and esthetic issues.
      • Early correction may be achieved surgically.
      • Minor malunions may not cause significant problems.
      • Sequestra can extrude, requiring surgical removal.

    Special Considerations for Mandibular Fractures

    • Pediatric fractures:
      • Uncommon in children, requiring modified treatment.
      • Children's bone is resilient and greenstick fractures are more common, with greater risk of developing tooth damage.
      • Healing is rapid, often stabilizing within a week and uniting within 3 weeks.
      • Treatment is primarily conservative.
      • Fractures can disrupt mandibular growth if permanent teeth or germs are lost.
      • Condylar fractures require special attention.
      • Fixation for young children:
        • Splint on the lower jaw with circumandibular wires.
        • Eyelet wires or arch bars with adequate teeth.
        • ORIF for significant displacement, avoiding damage to developing teeth.
      • Minor reduction imperfections: Compensated for by growth and eruption of teeth.
      • Prolonged follow-up: Monitoring for long-term growth and dentition effects.
    • Fractures of the Condyle:
      • Involve the synovial joint.
      • Classified into head of condyle (intracapsular) or neck of condyle fractures.
      • Treatment:
        • Conservative for intracapsular fractures and fractures in growing children.
        • Encourage immediate or early mobilization.

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    Fractures of the Mandible PDF

    Description

    This quiz covers the essentials of mandibular fractures, including their causes and classifications. Learn about the various types of fractures, the significance of teeth in fracture location, and crucial details about each classification. Perfect for dental and medical students seeking to deepen their understanding of this topic.

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