![]() ![]() ![]() If the patient is unconscious the initial evaluation should include the removal of material from the mouth which could potentially be aspirated (teeth, blood clots, road debris). This in most cases is either nasal intubation over a flexible bronchoscope or tracheostomy. If the airway is tenuous due to floor of mouth or tongue swelling or as the result of associated injuries the appropriate intervention outlined in the introductory section should be undertaken. The emergency intervention related to mandible fractures centers around airway management. Inspect the external auditory canals for fractures caused by impaction of the condylar heads. Palpate the external and intraoral surfaces of the mandible for step off's.ĥ. A thorough examination of the oral cavity including dentition, apparent class of occlusion, characterization of the occlusal disharmony present, maximal incisor opening and mucosal surfaces should be undertaken.ģ. The initial exam should assess the likelihood of significant floor of mouth swelling or tongue swelling that could potentially compromise the airway.Ģ. Head and neck exam with special attention to:ġ. Fractures may be vertically or horizontally favorable or unfavorable. If the muscles act to reduce the fracture it is a favorable fracture. If the muscle pull distracts the fragments the fracture is unfavorable. The muscles of mastication tend to distract some types of mandible fractures and reduce others depending on the anatomy of the fracture lines. Condyle fractures are more likely to occur as a result of forces directed straight posteriorly (uppercut and jab) whereas angle and body fractures are associated with medially directed trauma (the roundhouse punch). The areas most frequently fractured are the condyle, body and angle. ![]() In discussing mandible fractures, the mandible is generally divided into several different areas including, symphyseal (or parasymphyseal), body, alveolar process, angle, ramus, coronoid and condyle. Many of the fundamental concepts of dental and mandibular anatomy relevant to mandibular fractures has been reviewed in previous sections. Mandible Fractures Anatomy and Mechanism of Injury See sidebar for Introduction, Bibliography, and other Sections. The specifics of the surgery and the implants to choose from should be discussed in detail with your orthopaedic surgeon as this will vary depending on the type of injury and the specific location of the fracture within the bone.Return to: Facial Fracture Management Handbook ![]() This is important because the bone need to be correctly aligned to not only heal, but to heal without leaving the patient with a significant functional problem once they heal. The implants may include metal plates and metal screws, long hollow rods or nails that fit inside the central portion of the bone, wires and various other scary sounding tools! However, these items allow for the internal stabilization (like an internal cast) while surgically re-aligning the bones. The vast majority of these are designed to stay in the body forever and only are taken out if they are in certain areas that can cause pain in the future. These implants are commonly made of various metals such as titanium and stainless steal. This means that a formal incision is used (Open), the bones are re-aligned (Reduction), and an implant is used (Internal Fixation) to maintain that alignment so the body can naturally heal the fracture. One common term for operative fracture stabilization is called "open reduction internal fixation (ORIF)". The surgical procedures themselves are now becoming more and more minimally invasive as to decrease the overall "trauma" to the area of injury and to protect the local skin and muscles to a much greater extent. These implants are being improved upon very frequently with new technological advancements and with a better understanding of how fractures heal best. There are various methods to perform fracture "fixation" and certainly various types of implants that can be considered. If the fracture pattern, location or severity does not allow for this to occur, then the "open" surgery is performed to align the bones and provide a mechanism to stabilize them to allow for the appropriate healing. When treated "closed", these can often be placed into splints and casts to temporarily immobilize the injury and allow the body to heal it. This can occur by "closed" means (without using a surgical incision) or as an "open" surgery (a formal surgical procedure that requires an incision). The correct term to describe this for orthopaedic surgeons is to perform a "reduction". This is sometimes referred to by patients as having the bones "re-set". When a bone is broken (or fractured) and the pieces are sufficiently out of alignment or potentially unstable, then they need to moved back into position and stabilized. ![]()
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