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Contents.
Introduction.
Surgical anatomy
History.
Epidemiology.
Classification systems
Clinical features and diagnosis
Radiographic features
Conclusion.
References.
Introduction.
Maxillofacial injuries.
Mandibular fractures
prominence of mandible
Occlusion
Management.
Surgical anatomy
Strongest facial bone
mandible.
Weak areas of mandible
Junction between alveolar bone & basal mandibular
bone.
Ramus angle.
child & old obtuse
Alveolar ridge
Blood supply
Safe distance in mandible.
Average thickness of
Cortex in symphysis &
parasymphisis
region is 2.5 mm
Average thickness of
Cortex in premolar &
Body region is 3.5 mm
Distance between I.A.
Canal & cortex
At bicuspid - 4.0 mm
Molar region - 5.9 mm
Anteriorly distance
Between adjacent
Root apices is 3.7 mm
Posteriorly distance
Between adjacent
Root apices is 6.3 mm
Champys principles
Forces of mastication produce
tensional forces on upper border &
forces of compression on lower
border.
Anesthesia or parasthesia of
the nerve
Recovery / regeneration - 3 to
12 months
History.
Egyptian Papyrus (1650 BC)
Examination, diagnosis &
treatment.
Hippocrates Approximation of #
segments.
ASSAULTS
BIKE ACCIDENTS
Classification
General
Anatomical
Completeness
Mechanism of injury
Number of fragments
Shape of fracture
Direction & favorability of treatment
Presence or absence of teeth
AO classification.
Kruger's Classification
SIMPLE ( CLOSED) Linear fracture lines which do not communicate
with the exterior
IMPACTED One fragment is firmly driven within the other fragment and
clinical movement not appreciated
Impacted fracture
Dingman & Natvig classification
Symphysis fracture
Canine region
fracture
Body of the mandible
fracture
Angle fracture
Ramus fracture
Coronoid fracture
Condylar fracture
Dentoalveolar fracture
Direction & favorability of treatment
Horizontally Favourable
Fracture line runs
downward & forward so
upward displacement
avoided
Horizontally
Unfavourable
Fracture line runs Down
Wards and Back Wards
so
upward Displacement
Unrestricted
VERTICALLY FAVORABLE VERTICALLY UNFAVORABLE
FRACTURE LINE RUNS FROM THE FRACTURE LINE RUNS FROM THE
OUTER BUCCAL PLATE OBLIQUELY INNER LINGUAL PLATE OBLIQUELY
BACKWARDS AND LINGUALLY , MEDIAL BACKWARDS AND BUCCALLY , MEDIAL
MOVEMENT RESTRICTED MOVEMENT UNRESTRICTED
Presence or absence of teeth
Kazanjian V.H. & Converse J.M.
O STATUS OF OCCLUSION
A ASSOCIATED FRACTURES
F: NO. OF FRACTURES
F0 Incomplete fractures
F1 Single fractures
F2 Multiple fractures
F3 Comminuted fractures
O0 No malocclusion
O1 Malocclusion
O2 Edentulous mandible
A: Associated fracture
A0 None
A1 Dentoalveolar fracture
A2 Nasal bone fracture
A3 Zygoma fracture
A4 Lefort I
A5 Lefort II
A6 Lefort III
Clinical examination.
History
Mechanism of injury
Extraoral / Intraoral
Clinical features.
Extensive edema
Tenderness.
step deformity
bone crepitus
Facial asymmetry
Deviation of jaw Restriction of mouth
opening
Extensive soft tissue and bony defect
Collapsed arch and Open bite due bilateral poster
Interfragmentary mobility Gagging of occlusion
Sublingual
Displacement of fracture
Site of fracture.
- Commonly used.
- Entire mandible is visualized.
PA view.
Medial / lateral
displacement.
PNS view
Indicated for
Visualizing Medial
Displacement
Of Condylar Neck
Because of distortion in
Symphysis Region in
an OPG , an Occlusal
View is indicated in
Symphysial fractures
Condylar fracture.
To be continued..
References.
Oral & maxillofacial trauma- Fonseca,vol 1