Mandibular Fractures
The first and most important aspect of surgical correction is to reduce the fracture properly or place the individua segments of the fracture into the proper relationship with
each other. In the proper reduction of fractures of toothbearing bones, it is most important to place the teeth into the preinjury occlusal relationship. Merely aligning’ and interdigitattng-rhc bony fragments at the fracture sitewithout first establishing ‘a proper occlusal relatioriship rar ely results ill satisfactory. postoperative functional occlusion.
In the case of a fracture of an edentulqus patient, the mandibular dentures can be wired to the mandible with circum mandibular wiring, and the maxillary denture can
whom placement of arch bars and hone plates is difficult because of the configuration of ‘the deciduous teeth. because of developing permanent teeth, and because patient understanding and cooperation is difficult to
obtain. After a complete clinical and radiographic examination, all fractures and soft tissue injuries should Iw identified and categorized. Then, with input from the patient and the patient’s family, a treatment plan should
be. developed as to method and sequencin-g of surgl·ry. Discussion regardi ng closed ,:ersus open reduction. allY ·’period of 1\11\11a’,nd anticipated morbidity should lead to a decision, and surgical consent should be obtained.
weeks. Indications for open reduction include continued displacement of the bony segments or an unfavorable fracture, such as in an angle fracture (see Fig. 24-13), in which the pull of the masseter and medial pterygoid muscles can cause distraction of the proximal segment ;.’1 tho.’ mandible. With rigid fixation techniques, patients “.an ‘of
When open reduction is performed, direct surgical access-to the area of the fracture must be obtained. This access’ can be accomplished through several surgical – approaches, depending on the area of the mandible fractured. Both intraoral and extraoral approaches are possible.
Generally the symphysis and anterior mandible areas can be easily approached through an intraoral incision (Fig. 24-22), whereas posterior angle or ramus and condition
Currently techniques for rigid internal fixation ‘arc widely used for treatment of fractures. 7,11 use bone plates, bone screws, or both to fix t~1’:’~’f;l(‘t.r.c more rigidly and stabilizethe bony segments during hl·al-
·ing. (Fig. 24-26). Even with rigid fixation, a proper
occlusal relationship must ‘be established before reduction stabilization and flxatien of the bony segments. Advantages of rigid fixation techniques for treatment of mandibular fractures include decreased discomfort and
inconvenience to the patient because MMF is eliminated or reduced, improved postoperative nutrition, improved postoperative hygiene, greater safety for seizure patients, and, frequently, better postoperative management of patients with multiple injuries.
