Mandibular fractures 1 / fixed orthodontic courses

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Surgical Anatomy


Facial muscles attached


MUSCLES ATTACHED


Arterial supply


Venous supply


Nerve Supply


CLASSIFICATION
 Kruger’s

general classification

 Simple

or closed
 Compound or open
 Comminuted
 Complicated or complex
 Impacted
 Green stick
 Pathological
 Generalized

Skeletal diseases
 Localized skeletal diseases


 Rowe

Anatomical location

& Killy’s classification

 Fracture

not involving the basal bone- Dentoalveolar fracture
 Fracture involving the basal bone
 Single

unilateral
Condyle
 Coronoid
 Ramus
 Angle & Body
 Canine
 Symphysis


 Double

unilateral
 Bilateral fracture
Dislocation of the condyles
 Horizontal & vertical unfavourable fractures of the angles
 Bilateral fracture in the canine region
 Vertically and horizontally favourable
 Verically favourable but horizontally unfavourable
 Vertically unfavourable but horizontally favourable
 Vertically and horizontally unfavourable




Multiple fractures

Dingman & Natvigs classification
 Symphysis

fracture
 Canine region fracture
 Body of the mandible
fracture
 Angle Region
 Ramus region
 Coronoid region
 Condyler fracture
 Dentoalveolar region

Olsons study in 1982


According to direction of the fracture and
favorability for treatment
Horizontally favorable

Horizontally unfavorable

Vertically favorable

Vertically unfavorable

Relation of the fracture to the site
of injury
 Direct

fracture
 Indirect fracture


According to presence or absent of
tooth in relation to fracture line
Kazanjian

and Converse classification
 Class 1- When teeth are present on the both
side of the fracture line
 Class 2- When teeth are present on the one
side of the fracture line
 Short

edentulous posterior fragment
 Long edentulous posterior fragment
 Class

3 When both the fragments on each
side of the fracture line are edentulous.

Extended AO/ASIF cranio-maxillofacial
fracture classification of Haug & Greenberg
(1993).


ETIOLOGY OF FRACTURE
MANDIBLE


Typical Causes





Crush injuries






Direct violence
Indirect violence
Road traffic incident
Aero plane crashes
Mining accident

Predisposing causes



Presence of cysts, tumors, osteomyelitis, 3rd molars
Systemic diseases affecting the formation of
structure of bone

Clinical features








PAIN
ABNORMAL MOBILITY
BLEEDING
CREPITUS
DEFORMITY
ECHYMOSIS & EDEMA
FUNCTIONAL LOSS OR
INTERFERANCE IN FUNCTION

RADIOGRAPHS REQUIRED

OPG
PA VIEW

LATERAL OBLIQUE VIEW

OCCLUSAL

IOPA

CT SCANS

Basic principles for Rx of Fracture
Reduction
 Closed
 Direct

interdental
wiring Indirect
interdental wiring
(eyelet or Ivy loop)
 Continuous or
multiple loop wiring
 Arch bars
 Cap splints
 'Gunning-type'
splints
 Pin fixation



Open












Transosseous
wiring
(osteosynthesis)
Plating
Intramedullary
pinning
Titanium mesh
Circumferential
straps
Bone clamps
Bone staples
Bone screws

Fixation
 Direct
 Indirect

Immobilization
 Methods of immobilization
 (a)

Osteosynthesis without intermaxillary fixation

 (i)

Non-compression small plates
 (ii) Compression plates
 (iii) Mini-plates
 (iv) Lag screws
 (b)

Intermaxillary fixation

 (i)

Bonded brackets
 (ii) Dental wiring
Direct
 Eyelet


 (iii)

Arch bars
 (iv) Cap splints
 (c)

Intermaxillary fixation with osteosynthesis

 (i)

Transosseous wiring
 (ii) Circumferential wiring
 (iii) External pin fixation
 (iv) Bone clamps
 (v) Transfixation with Kirschner wires

Guide for time of immobilization
Young adult with
Fracture of the angle
receiving Early
treatment in which
Tooth removed from
fracture line

3 weeks

IF
(a) Tooth retained in fracture line: add 1 week
(b) Fracture at the symphysis: add 1 week
(c) Age 40 years and over: add 1 or 2 weeks
(d) Children and adolescents: subtract 1 week

CLOSED REDUCTION
 HISTORY

William Saliceto(1210-1277) Tied the teeth (MMF)
 Thomas Gilmer(1849-1931) Reveiwed the tech,
introduced Arch Bars in 1907.
 Barton bandage by JOHN BARTON
Lingual-Labial occlusal splint.
Vaccum formed acrylic splint
Royal Berkshire Haio Frame



DIRECT INTERDENTAL WIRING


INTERDENTAL EYELET WIRING
IVY LOOP METHOD


WILLIAMS
MODIFICATION(1968)


LEONARD BUTTON WIRING


CLOVE HITCH TECH
IN CASE OF SINGLE TOOTH


STOUT METHOD(1943)
 Continous

or Multiple
loop wiring


Fulton Risdon (1968)
 Twisted

Labial Wire


OBWEGESER METHOD


Continous Multiple Loop Wiring




ARCH BARS

RISDON ARCH BAR
JELENKO ARCH BAR
ERICH ARCH BAR
KRUPPA ARCH BAR
ERICH ARCH BAR
HAMILTON (1967)


BARKER(1986)


ACRYLATED ARCH BARS
schuchardt(1956)
schuchardt&metz(1966)
stanhope(1969)
clarke(1977)


DIRECTLY BONDED ARCH BARS
Baurmash et al(1988)
Wall(1986)


CAP SPLINTS
1. Cast silvercap splints
2.Acrylic splints
ROBTERTSON(1965)


FRACTURES OF EDENTULOUS
MANDIBLE
 GUNNING

TYPE

SPLINTS

THOMAS BRYAN
GUNNING-(1885)


TREATMENT MODALITIES FOR
EDENTULOUS MANDIBLE
PERALVEOLAR
WIRING


The Obwegeser
technique for
circumferential wiring

CIRCUMMANDIBULAR
WIRING (Bradley-1975)


 INTER

OSSEOS WIRING
 EXTRA ORAL PIN FIXATION
ROGER ANDERSON APPLIANCE
 PRIMARY RIB GRAFTING
- OBWEGER& SAILER (1973)


OPEN REDUCTION
HISTORY

1. Gorden Buck(1807-1877)
2. Hansmann(1886)
3. Christiansen(1954)
4. Luhr(1968)
5. Spiessel(1970 & 1974)
6. Schmoker & Niederdellmann & Schilli(1973)
7. Michelet & Champy(1978)
8. Marciani & Gonty(1993)
9. Ellis(1993 & 1996)

Surgical approaches to the
mandible
Intraoral symphysis and paarasymphysis

Intraoral body, angle
and ramus

Extraoral approaches

Submental
Submandibular

Submandibular approach


Retromandibular approach


Transosseous wiring


Hayton Williams method


Compressive and tension forces


Mini plates


Lag screws


Compression plating


DCP AND EDCP


Reconstruction plate


Comminuted fracture treated


Kirschner wiring


COMPLICATIONS
 Non-Union
 Malunion
 Fibrous

Union
 Paresthesia
 Anesthesia
 Infection


Conclusion


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Mandibular fractures 1 / fixed orthodontic courses

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