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Mandibular trauma

Ari Aso
Ary Kayrolla

What is mandibular trauma(mandibular fracture)

Mandibular fracture, also known as fracture of the jaw, is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums.

Etiology of mandibular fractures

1-vehicular accidents 43%
2-altercation,assaults,battery,interpersonal violence 34%
3-work accidents 10%
4-fall 7%
5-sports injuries 4%
6-pathological fractures 2%

Areas of weakness(vulnerable to fracture)

1-the junction of the alveolar bone and the basal mandibular bone creates a line of weakness .
2-symphysis region is formed by the bony union of 2 halves of the mandible in the center is seen as are of weakness .
3-parasymphysis region lateral to the mental prominence is a weak area this is because of the presence of the incisive fossa and mental foramen.
4-the junction between the body and the ramus of the mandible form a line of structural weakness.
5-strength of the lower jaw varies with the presence or absence of teeth, the presence of impacted lower 3rd molar or excessive long roots of canine makes the area more vulnerable for fractures.
6-the slender neck of the mandibular condyle renders it to fracture as a result of direct violence, this anatomical weakness actually acts as a safety mechanism, as a fracture of the neck of the condyle prevents injury to the middle cranial fossa .


Sign and symptoms of mandibular fracture
1-pain.
2-trumatic malocclusion.
3-numbness.
4-trismus.
5-swelling, bruising and deformity.
6- eccymosis or hematoma .
7-open bite.

Classification of mandibular fractures

dingman and natvig classification by anatomic region :

Kruger's general classification

1-simple or closed : a linear fracture which does not have communication with the external environment .
2-compound or open :this fracture has communication with the external environment .
3-comminuted : a fracture in which the bone is splintered or crashed into multiple pieces .
4-complicated or complex : fractures associated with the damage to the important vital structure complicating the treatment as well as prognosis .
5-impacted :fracture in which one fragment is firmly driven into the other fragment .
6-greenstick : a fracture in which one cortex of the bone is broken with the other cortex being bent.
7-pathological :fracture of the mandible occurring from mild injury or as a result of a normal degree of muscular contraction .

Classification according to the direction of fracture and favorability for treatment

Management

Reduction refers to approximating the ends of the bones edges that are broken. This is done with either an open technique or a closed technique .
Closed reduction is a procedure for putting the pieces of a broken bone back into the right position without surgery.
Open Reduction Internal Fixation (ORIF) is a surgery done to fix a bone using surgical plates, nails, screws or pins.