Recent advancement in management of madibular fractures
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This is my topic about recent advancements in managment of mandibular fractures till 2016.Credits to oral and maxillofacial surgery.
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Recent advancement in management of madibular fractures
- 2. RECENT ADVANCES IN MANAGEMENT OF MANDIBULAR FRACTURES DONE BY R.G.ASHWANTH DEEPAK CRRI
- 3. INTRODUCTION • Mandible is a strong bone,force requiring to fracture ranges from 44.6 to 74.4 kg/m yet mandible gets mostly fractured because of its anatomical postion in the maxillofacial region.
- 4. Anatomy
- 6. BLOOD SUPPLY
- 7. NERVE SUPPLY
- 9. Signs and symptoms • Pain • Swelling • Ecchymosis • Jaw stiffness • Trismus • Open bite • Airway blockage • bleeding
- 10. CLASSIFICATION DINGMAN AND NATVIG CLASSIFICATION based on anatomic region 1.Symphysis#(midline #) 2.Parasymphysis#(canine#) 3.Body of mandible# (between canine and angle#) 4.Angle region# 5.Ramus# 6.Coronoid# 7.Condylar# 8.Dentoalveolar# Classification: Kruger,Rowe and Killey,Dingman and natvig.
- 11. 1.favourable: a.Horizontally favourable b.Vertically favorable 2.unfavourable: a.Vertically unfavourable b.Horizontally unfavourable
- 12. HISTORY 1844 ERICH AND AUSTIN PREANTIBIOTIC ERA,CLOSED REDUCTION 1847 BUCK TRANSOSSEOUS SILVER WIRING 1943 CORDON WIRE SUTURING,STAINLESS STEEL INTRAOSSEOUS WIRING PLUS MMF 1970 SPIESSEL AO/ASIF-COMPRESSION PLATE 1973 MICHELET NONCOMPRESSION MONOCORTICAL SCREWS WITH MINIPLATE SYSTEM 1978 CHAMPY IDEAL OSTEOSYNTHESIS LINES
- 13. MANAGEMENT OF MANDIBULAR FRACTURS IN ADULTS CURRENT LINE OF TREATMENT • The purpose of all therapy of fracture is restoration of original from and function. • SURGICAL APPROACH • REDUCTION • FIXATION • IMMOBILIZATION
- 14. SURGICAL APPROACH CURRENT TECHNIQUE • PROPER INCISION (BLADE AND ELECTRO CAUTRY) • USE OF PRE EXSISTING LACERATION a)INTRA ORAL APPROACH: *SYMPHYSIS AND PARASYMPHYSIS-DEGLOVING INCISION *BODY,ANGLE,RAMUS-TRANS BUCCAL INCISION *INTRA ORAL APPROACH TO CONDYLE b)EXTRA ORAL *SUB MANDIBULAR-RISDON’S INCISION *SUB MENTAL,SUB MANDIBULAR,RETRO MADIBULAR *Facelift (rhytidectomy) approach *PRE AURICULAR APPROACH
- 15. DEGLOVING INCISON TRANSBUCCAL INCISION RISDON’S INCISON
- 16. LACERATIONS SUB MENTAL APPROACH FACE LIFT APPROACH PRE AURICULAR INCISION
- 17. SURGICAL APPROACH- LASERS IN INCISION • LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATON • MONOCHROMATIC AND COHERENT ADVANTAGES: • INCRESED BONE HEALING • REDUCED RISK OF INFECTION • LESS NEED OF ANAESTHESIA • LESS BLEEDING,NOISE,POST OP PAIN • BETTER RESULTS
- 18. # REDUCTION COVENTIONAL TECHNIQUE 1.CLOSED REDUCTION a)EXTERNAL REDUCTION DEVICES b)INTRAORAL AND EXTRAORAL TRACTION 2.OPEN REDUCTION a) RIGID AND NON RIGID FIXATION
- 19. EXTRA ORAL TRACTION EXTRA ORAL REDUCTION DEVICES
- 20. CLOSED REDUCTION RECENT ADVANCEMENTS Hollow 18-gauge needle taken from intravenous cannula for pediatric patients Instead of coventional arch bar An indigenous method for closed reduction of pediatric mandibular parasymphysis fracture
- 21. FIXATION(conventional methods) 1.INDIRECT FIXATION(CLOSED FIXATION): • INTERMAXILLARY FIXATION OR MAXILLOMANDIBULAR FIXATION • CRANIOMAXILLARY OR MANDIBULAR SUSPENSION • EXTERNAL FIXATION 2.DIRECT FIXATION(INTERNAL FIXATION): • SEMIRIGID FIXATION: a)TRANSOSSEOUS WIRING b)NONCPMPRESSION MINIPLATES • RIGID FIXATION: a)COMPRESSION PLATES b)LAG SCREWS c)RECONTRUCTION PLATES
- 22. INTERMAXILLARY FIXATION MANDIBULAR SUSPENSION EXTRA ORAL TRACTION TRANSOSSOEUS WIRING MANDIBLE NON COMPRESSION MINI PLATES COMPRESSION PLATES
- 24. Champy’s ideal lines of osteosynthesis • Champy performed a series of experiments with miniplate that delineated “ideal lines of osteosynthesis”within the mandible,they are the ideal areas for plates and screws placement.
- 25. • Masticatory muscles produce tension at upper border and compression at lower border. • Torsional forces produced anterior to the canines • Monocortical “tension banding “ osteosynthesis neutralizes distraction and torsion during physiologic stress,while normal basilar compression is restored
- 27. RECENT ADVANCEMENTS IN FIXATION 1.BIO RESORBABLE PLATES 2.THREE DIMENTONAL PLATES
- 28. CONSEQUENCES OF NOT REMOVING THE PLATE 1) PALPABLE OR PROMINENT HARDWARE 2) LOOSENING OF PLATES AND SCREWS 3) PAIN 4) INFECTION 5) WOUND DEHISCENCE 6) THERMAL SENSITIVITY 7) PLATE MIGRATION
- 29. BIO RESORBABLE PLATES • DESPITE TITANIUM PLATES AND SCREWS BEING GOLD STANDARD IT HAS FEW DISADVANTAGES AS FOLLOWS(ESPECIALLY RIGID FIXATION): 1) GROWTH DISTURBANCE 2) PLATE MIGRATION 3) NEED FOR SUBSEQUENT REMOVAL 4) INCOMPATIBLITY WITH FUTURE IMAGING NEEDS 5) LONG TERM PALPABILITY 6) THERMAL SENSITIVITY 7) MALUNION 8) DIFFICULTY IN CONTROLLING POST OPERATIVE OCCLUSION
- 30. CHEMICAL COMPOSITION: A)Polyglycolic acid B)Polylactic acid C)Polyesterspolyparadioxanon ALPHA compounds
- 31. • FEATURES : 1) INCREASED TENSILE AND FLEX STRENGTH 2) EASILY ADAPT 3) VARIETY OF SIZES AND SHAPES 4) HEX DRIVE BREAK AWAY DELIVERY SYSTEM SIMPLIFIES SCREW PLACEMENT 5) ELIMINATES GROWTH RESTRICTION AND IMPLANT MIGRATION 6)RESORB COMPLETELY AND ELIMINATES SECOND SURGERY 7)NO LATE STAGE INFLAMMATORY REACTION
- 32. • Biodegradable plate are strong,biocompatible,adaptable and has enough stability • Resorb quickly without any foreign body reaction.
- 33. • MECHANISM OF ACTION: BIORESORBABLE PLATES METABOLIZED BY LIVER BULK HYDROLYSIS(COVERT INTO CO2 AND H2O)
- 34. ADVANTAGES • SMALL • BIOCOMPATIBLE • ADAPTABLE • ADEQUATE STABILITY TO ACHIEVE BONE UNION • RESORBS IN TIMELY FASHION
- 35. TITANIUM VS BIODEGRADABLE PLATES TITANIUM PALTES BIO DEGRADEBLE PLATES HARD AND STRONG SOFTER AND WEAKER FIRM TIGHT PRESSURE FINGER TIGHT PRESSURE RADIOGRAPHICALLY APPARENT NOT RADIOGRAPICALLY APPARENT USES • FRACTURE FIXATION IN TOOTH BEARING REGION • A BONE ANCHORED METHOD OF MAXILLOMANDIBULAR FIXATION • VERY LOW LOAD BEARING AREAS • PEDIATRIC CRANIOFACIAL OSTEOTOMU FIXATIONS
- 36. BIO RESORBABLE PLATE FIXATION • STEP 1: HEATING THE PALATE AND BENDING • STEP 2:PRE TAPPING SCREW HEADS BEFORE TAPPING
- 37. BIO RESORBABLE CERAMIC MATERIALS • European Research Project Develops New Resorbable Bioceramic Materials #They closely match the mechanical requirements of the implant sites http://www.odtmag.com/contents/view_videos /2016-04-01/european-research-project- develops-new-resorbable-bioceramic-materials
- 38. Three dimensonal mini plates • They are known for their good stability due to the closed quadrangular geometric shape. • Ease of contouring and adapting • Better inter fragmentary stability
- 39. • No need for supplementary fixation • Immediate post op jaw fixation • Minimal surgical exposure • Decresed periosteal stripping • Decreased hardware complications.
- 40. • Plating System • Plates • Design: • Square plate (1 cm × 1 cm) • Rectangular plate (1 cm × 0.5 cm) • Continuous Square or Double Square (2 cm × 1 cm)
- 41. Continuous rectangle or double rectangle (2 cm × 0.5 cm) Double rectangle with an intervening square (2 cm × 1 cm) Diameter of plate hole: 2 mm Thickness: 1 mm (Standard plates)
- 42. • The treatment of mandibular fractures (symphysis, parasymphysis, and angle) with 3- dimensional plates provided 3-dimensional stability and carried low morbidity and infection rates. • The only probable limitations of 3-dimensional plates were excessive implant material due to the extra vertical bars incorporated for countering the torque forces.
- 43. IMMOBILISATION • INTERMAXILLARY FIXATIONOR MAXILLOMANDIBULAR FIXATION • AVERAGE RECOMMED TIME FOR IMMOBILISATION: 6WEEKS FOR ADULTS(TILL BONY CALLUS STAGE OF SECONDARY BONE HEALING
- 44. MANGEMENT OF FRACTURE NON UNION OR MALUNIONS(ADVANCEMENTS)
- 45. RECOMBINANT BONE MORPHOGENIC PROTIEN • BMPs are subfamily if TGF-𝑏𝑒𝑡𝑎 super family • BMPs derived from osteoblasts,chondrocytesand platelets • BMPs induce osteogenisis,chondrogenesis and angiogenisis and extracellularmatrix • Thus they induce denovo bone synthesis at the site where they are implanted. OSTEOINDUCTIVE PROPERTIES: • Mesenchymal cell infiltration • Cartilage formation • Vascularisation • Bone formation • Remodelling of new bone
- 46. Complicatiions: • Exaggerated inflammatory response • Ectopic bone formation • Non responders
- 47. ALLOPLASTIC GRAFTS • Alloplastic grafts are made from hydroxyapatite, a naturally occurring mineral (main mineral component of bone), made from bioactive glass. • Hydroxyapatite is a synthetic bone graft, which is the most used now due to its osteoconduction, hardness, and acceptability by bone. • properties: 1. resorbable in long run. 2. Osteogenic potential. 3. Bioactive.
- 48. Osteoconduction •Osteoconduction occurs when the bone graft material serves as a scaffold for new bone growth that is perpetuated by the native bone. •Osteoblasts from the margin of the defect that is being grafted utilize the bone graft material as a framework upon which to spread and generate new bone.
- 49. Types of alloplastic materials • Dimethysiloxane(silicone): Parasymphyseal and symphyseal non unions • Polytetrafluoroethylene • Polyethelene • Polyesters • Acrylics: polymethyl methacrylate,hard tissue replacement,bioplant hard tissue replacement • Calcium phosphate ceramics
- 50. Bone healer and graft enhancer • PRP gel: Platelet rich plasma It is a caogulated platelet made from persons own blood bycentrifugation,sequesteration and concerntation platelets. Preparation:
- 51. Stem cells • One of the human body's master cells, with the ability to grow into any one of the body's more than 200 cell types • Bone marrow stem cells Hybrid graft Enhance oesteogenic potential • Coral scaffold +marrow stomal cells=tissue engneered artificial bone.