Mandibular fractures

 

         Fractures involving the mandible. Major causes includes, vehicular accidents, interpersonal violence/assaults, falls, contact sports, industrial/work related, pathological fractures.

Types of Mandibular fractures:

-- Simple (includes a closed linear fractures)

-- Compound/open

-- Comminuted

-- Greenstick

-- Pathologic

-- Multiple

-- Impacted

-- Atrophic

-- Complicated/complex.

Classification of mandibular fractures based on the Anatomic region: -- Condylar process -- Coronoid process -- Ramus -- Angle -- Body -- Symphysis -- Para symphysis -- Alveolar process.

Signs and Symptoms :

Coleman’s sign : There is one sign which is almost pathognomonic of fracture of the body of the mandible, and that is an effusion of blood in to the floor of the mouth raising its mucous membrane and producing a characteristic bluish, tense swelling under the tongue.

Symptoms : symptoms of broken jaw include, Pain, Swelling including facial swelling, Bleeding including bleeding from the mouth, Breathing difficulties, Discomfort when chewing, Jaw stiffness, Numbness and bruising in the face, Dental related discomfort such as numbness in gums and loosened teeth.

Treatment protocol :

ATLS protocol : Advanced Trauma Life Support

Primary survey : A-- Airway maintenance and Cervical spine protection B-- Maintenance of breathing and ventilation C-- Circulation and hemorrhage control D-- Disability/Neurological examination-AVPU E-- Exposure under proper environment.

Secondary survey : Head to toe complete evaluation, including a complete history and physical examination and reassessment of all vital signs

Tertiary survey : In hospital care.

Definitive In-Hospital treatment:

A. Reduction : Restoration of functional alignment of bone fragments. Two methods,

1.Open reduction. Indications : -Displaced unfavorable fractures, multiple fractures of facial bones

- Midface fractures and displaced bilateral condylar fracture

- Fractures of an edentulous mandible with severe displacement of fracture segment

- Edentulous maxilla opposing a mandibular fracture

- Delay in treatment and interposition of soft tissue between non-contacting displaced fracture fragments

- Malunion

- Conditions contraindicating intermaxillary fixation  

2.Closed reduction. Indications:

- Non displaced mandibular fractures

- Grossly comminuted fractures

- Significant loss of overlying soft tissue

- Edentulous mandibular fractures

- Mandibular fractures in children

- Coronoid process fractures

- Condylar fractures.

B. Fixation and Immobilization : To allow bone healing through fixation of fracture line.

Methods of immobilization:

1. Intermaxillary fixation with osteosynthesis

- Trans-osseous wiring

- Circumferential wiring

- External pin fixation

- Bone clamps

- Trans-fixation with Kirschner wire

2. Intermaxillary fixation without Osteosynthesis

- Compression plates

- Miniplates

- Lag screws

Dental wiring techniques : Esig’s wiring, Gilmer’s wiring, Risdon’s wiring, Ivy eyelet wiring, Clovehitch wiring, col. Stout’s multiloop wiring, Button wiring.

About the author:

Name: Dr. Abhilash Dandy

Qualification: B.D.S

I graduated as a Dentist from Sibar Institute of Dental Sciences, Guntur. I have done my externship program at Rutgers school of dental medicine, New Jersey, USA. I have clinical experience of 3 years and currently working as Administrative head — Dental wing in MediCub India, Hyderabad.