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1. INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com

2. MAXILLOFACIAL INJURIES
• SMELL
• EAT
• SIGHT
• HEAR
• TALK
• BREATHE
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

3. MAXILLOFACIAL INJURIES
Primary management (ABCDE)
Neurological assessment (GCS)
Control of pain
analgesics
Control of infection
antibiotics
Surgical planning
GK / MAXFAC
SDM DHARWAD
www.indiandentalacademy.com

4. MAXILLOFACIAL INJURIES
TRAUMA: PHYSICAL FORCE RESULTS IN INJURY
2
F = mv
ETIOLOGY
• ASSAULTS
• FALL
• INDUSTRIAL ACCIDENTS
• RTA
• SPORTS INJURIES
• WAR INJURIES
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

5. MAXILLOFACIAL INJURIES
SERIOUS TRAUMA :DEATH
TRIMODAL DISTRIBUTION
SECONDS TO MINUTES
MINUTES TO HOURS
(GOLDEN HOUR)
AFTER DAYS
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

6. MAXILLOFACIAL INJURIES
GOLDEN HOUR
COMPLICATIONS
UNRECOGNIZED SERIOUS
AIRWAY,HEMMORHAGE
CERVICAL SPINE
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

7. MAXILLOFACIAL INJURIES
GOLDEN HOUR
AIRWAY
BREATHING
CIRCULATION
DEFORMITY
EXPOSURE
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

8. MAXILLOFACIAL INJURIES
GOLDEN HOUR
AIRWAY
SUCTION
CHIN LIFT JAW THRUST
AIRWAYS
CRICO/TRACHY
OXYGEN
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

9. MAXILLOFACIAL INJURIES
GOLDEN HOUR
BREATHING
CHEST INJURY
Pneumothorax
Cardiac tamponade
Ruptured diaphram
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

10. MAXILLOFACIAL INJURIES
GOLDEN HOUR
CIRCULATION
I.V ACCESS
TRANSFUSION
Hypovolemia-
SHOCK
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

11. MAXILLOFACIAL INJURIES
GOLDEN HOUR: CIRCULATION
Hypovolemic shock
Tachycardia, hypotension
cold clamy skin, loss of peripheral pulse,
falling urinary output
Confusion & disorientation
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

12. MAXILLOFACIAL INJURIES
GOLDEN HOUR
DISABILITY
patient’s response ‘AVPU’
Awake
Verbal stimuli
Painful stimuli
Unconcious
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

13. MAXILLOFACIAL INJURIES
Secondary survey
ABDOMEN
Occult blood sequestration
Tenderness / acute abdomen
Gastric decompression(N.G tube)
Direct peritoneal lavage
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

14. MAXILLOFACIAL INJURIES
Secondary survey
EXTREMITIES
Reduced perfusion
Traumatic amputation
Compartmental syndrome
Site for major blood loss
(1-6 units)
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

15. MAXILLOFACIAL INJURIES
DIAGNOSIS & TREATMENT PLAN
Eye witness report
Clinical diagnosis (ABCDE)
Neurological examination
- G.C.S
- Cranial Nerves
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

16. MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION
Inspection
•
•
•
•
•
Swelling
Hematoma,
Skin lacerations/defects,
Facial nerve
Mouth opening
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

17. MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION
Palpation
•
Tenderness
•
Crepitation
•
Contour irregularities (step)
•
Depressed / Penetrating
bone
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

18. MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION
Ear
• Hematoma
• Laceration
• CSF ottohorea
• Tympanic membrane
• Obstruction
• Laceration
• Haematoma
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

19. MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION
Eye
• Visual acquity, perception of light
• Position of eye: pupil levels
enophthalmos
proptosis
• Diplopia
• Restricted movements
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

20. MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION
Nose
• Swelling
• Septal deviation
• Mobility and crackling
• Mucosal lacerations
• Epistaxis
• CSF Rhinorrhoea
• Anosmia?
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

21. MAXILLOFACIAL INJURIES
EXTRAORAL EXAMINATION
Soft tissues
(contusion
tissue loss)
Foreign bodies
Nerves
Ducts
Blood vessels
(remember tetanus)
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

22. MAXILLOFACIAL INJURIES
INTRAORAL EXAMINATION
Inspection
• Asymmetry, Swelling
• Bleeding, Hematoma
• Occlusal plane / Step deformity
• Mucosal lacerations
• Teeth: fracture
avulsion
dislocation
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

23. MAXILLOFACIAL INJURIES
INTRAORAL EXAMINATION
Palpation
• Bimanual
• Tenderness
• # line / Step deformity
• Crepitation
• Teeth movement, Number
• Missing parts
• Sensory distribution of V1V2V3
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

24. MAXILLOFACIAL INJURIES
INTRAORAL EXAMINATION
Salivary glands
duct
orifice
Tongue
ventral surface
dorsal surface
movements
Hard/Soft palate
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

25. MAXILLOFACIAL INJURIES
RADIOGRAPHIC EXAMINATION
Based on clinical examination
Plain radiographs
Location & Severity of fractures
Radio-opaque foreign bodies
CT scans
Intracranial injuries
Orbital & naso-ethmoidal injuries
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

26. MAXILLOFACIAL INJURIES
Classification of fractures
1)Relation to overlying soft tissues
Closed / Simple
Open / Compound
Complicated
2)Type of fracture
Green stick
Single
Multiple
Comminuted
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

27. MAXILLOFACIAL INJURIES
Classification of fractures
3)Type of fracture
Green stick
Single or Multiple
Comminuted
( oblique / transverse / sagital & degree of dislocation )
Additional features
Pathologic
Atrophic
Impacted
Direct / indirect (contra-coup)
Blow out / in
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

28. MAXILLOFACIAL INJURIES
Classification of fractures
4) Anatomic site of fracture
Midface
• Frontal bone / sinus
• Zygomatic arch
• Zygomatic complex / malar
• Orbit
• Nose
• Naso ethmoidal
• Maxilla
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

29. MAXILLOFACIAL INJURIES
Management
Primary management (ABCDE)
Neurological assessment (GCS)
Control of pain
analgesics
Control of infection
antibiotics
Surgical planning
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

30. MAXILLOFACIAL INJURIES
Classification of fractures
4) Anatomical site of Fracture
Mandible
symphysis
body
ramus
condylar
intracapsular
parasymphysis
angle
coronoid
(dento) alveolar
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

31. MAXILLOFACIAL INJURIES
Surgical management
Pan facial trauma 3d reconstruction
AP dimension zygomatic arch
Horizontal dimension zygoma to FZ suture
Anterior vertical dimension frontal bar and NE#
Posterior vertical dimension condylar fractures
Restore occlusion I.M.F
Stabilize mandibular fractures
Maxilla at Lefort 1 (teeth bearing)
Soft tissue repositioning
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

32. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
• Classification
• Applied surgical anatomy
• Clinical features
• Radiological features
• Management
immediate
definitive
• Complications
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

33. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
anatomical site
• symphysis
• parasymphysis
• body
• angle
• ramus
• condyle
• coronoid
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

34. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Classification
Displacement of fractured site
favourable / unfavourable
horizontal - vertical
# with reference to dentition
Dentulous jaw adult / child
Edentulous jaw
Dentulous jaw with posterior edentulous fragment
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

35. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Surgical anatomy
Areas of weakness
• teeth
• foramen
• alveolar bone
• angle
• ramus
• condyle
Blood supply
Nerve supply
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

36. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Clinical features - Inspection
• Haemorrhage
• Pain
• Swelling
• Altered occlusion
• Sublingual haemorrhage
• Disturbed function
• Halitosis
• Paresthesia
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

37. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Clinical features - palpation
• Confirm inspectory findings
• Tenderness
• Fracture line/step
• Crepitation
• Paresthesia
• Abnormal mobility
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

38. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Radiographic features
OPG / Lateral oblique
P A mandible
Intra oral occlusal view
Confirms
Site and severity of #
Direction & displacement of #
Condition of teeth in line of #
Presence of bony pathology
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

39. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Management objectives
RESTORE FORM & FUNCTION
Remember A B C D E
Precise diagnosis
Early reduction
Adequate fixation and immobilization
Rehabilitation /restoration of functionGK / MAXFAC
www.indiandentalacademy.com
SDM DHARWAD

40. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
REDUCTION Closed
Advantages
No need for a G.A
Can be used in comminuted #
Continuity defects ( missile injuries)
Disadvantages
Accuracy of reduction ambiguous
Poor fracture allignment
Innadequate reduction
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

41. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
REDUCTION Open
Exposure of fracture skin / mucosa
Direct reduction and fixation
Transoseous Wiring
Plate & Screw Osteosynthesis
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

42. MAXILLOFACIAL INJURIES
Applied anatomy
Muscle attachments:
Depressors
Digastric
geniohyoid
Elevators
temporalis
masseter
medial pterygoid
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

43. MAXILLOFACIAL INJURIES
Mandibular fractures
Classification
Classification
Kazanzian & Converse
Kazanzian & Converse
Class II Teeth on both segments
Class Teeth on both segments
Class II teeth on onw segment
Class II teeth on onw segment
Class III Edentulous
Class III Edentulous
Rowe & Lilley
Rowe & Lilley
#s involving the basal bone
#s involving the basal bone
#s not involving the basal bone
#s not involving the basal bone
favourable // unfavourable
favourable unfavourable
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

44. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY
central support to cheek
buttress of lateral mid 3rd face
Articulations
Zygomatico frontal
Infra orbital rim
Zygomatico maxillary
Zygomatico temporal (arch)
Zygomatico sphenoid(orbital floor)
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

45. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY
Processes
Temporal - arch
Orbital - sphenoid
Frontal – external angular process
Maxillary - infra orbital rim
lateral wall and floor orbit
roof and lateral wall maxillary sinus
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

46. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY
Arch
Temporal
Zygoma
Maxilla
Muscle attachments
Zygomaticus major/minor: malar eminenece
Levator labi superioris:infraorbital rim
Masseter : arch & Tuberosity
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

47. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Mechanism of Injury
Direct & Indirect
Inbending area of impact
Out bending of weak areas (distant)
# always includes floor discontinuity
Dislocation
posterior
inferior
medial
lateral
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

48. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Classification
Based on
1 Direction of dislocation
- rotation in several planes
2 Success of reduction
- intact buttress
- stability
Rotation: vertical & longitudinal
Displacement : medial , lateral
posterior, inferior
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

49. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Classification
Knight & North (1961)
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
no significant displacement
arch fractures
unrotated body fractures
medial rotation
lateral rotation
complex fractures
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

50. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Classification
Rowe & Killey (1968)
Type 1 no significant displacement
Type 2 arch fractures
Type 3 rotation vertical axis:
internal
external
Type 4 rotation longitudinal axis:
medial
www.indiandentalacademy.com
lateral
GK / MAXFAC
SDM DHARWAD

51. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Classification
Rowe & Killey (1968)
Type 5 displacement en bloc
medial
inferior
lateral
Type 6 depression in orbito-antral portion
inferior
superior
Type 7 orbital rim segment
Type 8 complex www.indiandentalacademy.com #
comminuted
GK / MAXFAC
SDM DHARWAD

52. MAXILLOFACIAL INJURIES
ZYGOMATIC COMPLEX FRACTURES
Classification
Applied surgical anatomy
Clinical features
Radiological features
Management
immediate
defnitive
Complications
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

53. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Flattening of cheeck
Peri orbital edema/echymosis
Subconjunctival haemorrhage
Epistaxis
Paresthesia (V2)
Trismus
Tenderness/step deformity
DIPLOPIA www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

54. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Classification
stable fractures:
arch fractures
latreal rotation around vertical axis
posterior displacement
unstable fractures:
medial rotation around longitudinal axis
medial, lateral or inferior displacement
complex fractures
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

55. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features: DIPLOPIA
Downward displacement
Expansion of floor of orbit
Contusion of extra occular muscles / fat
Haematoma / edema in orbital soft tissue
Floor /Medial wall incarceration
‘Blow out Fractures of orbit’
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

56. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
DIPLOPIA
Whitnall’s tubercle (7mm below FZ suture)
Lateral canthal ligament
Lockwoods suspensory ligament
Lateral horn of levator
Downward displacement
Expansion of floor of orbit
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

57. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
diplopia
Soft tissue ligaments(Leo Koorneff)
(Connect periosteum & interlace
soft tissue to muscle and globe)
Incarceration to # fragments
Impaired extra occular muscle motion
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

58. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Enopthalmos
Inferior posterior displacement
Expansion of globe
Migration of soft tissue
(medial inferior & lateral)
Exopthalmos
Medial dislocations
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

59. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination
Occiputomental view (PNS view, Waters positon)
Fronto zygomatic suture
zygomatico maxillary buttress
infrior orbital rim
Submeto-vertex view
(jug handle view)
Zygomatic arch
Posterior displacement
C.T Scans
axial
coronal
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

60. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

61. MAXILLOFACIAL INJURIES
Mandibular Fractures
Applied anatomy
Curved bone
Thickness of cortices
Neurovascular bundle
Dentition
Attachment of Muscles
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

62. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
CLOSED REDUCTION
AIM:Immobilization (IMF)
Direct wiring
Ivy Eylet wiring
Arch Bar Wiring
Extra oral pin fixation
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

63. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
Open REDUCTION
Plate & Screw Osteosynthesis
Titanium/Stainless steel
Compression plates
Mini plates
Lag Screw
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

64. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
Open REDUCTION
Dynamic Compression Plates
Extraoral approach
Bicortical Screws
Excentric/neutral holes
Gap at upper border – tension band
Direct healing no callus
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

65. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
Open REDUCTION
Miniplate Osteosynthesis (Champy)
# displacement due to muscles
Biomechanical solution
neutralization of unfavourable
forces
Mechanical charecteristics
Contain forces of muscles
GK / MAXFAC
SDM DHARWAD
Adequately rigid
www.indiandentalacademy.com

66. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
Open REDUCTION
Miniplate Osteosynthesis (Champy)
Small malleable plate
Trans oral approach
Monocortical fixation
Defined osteosynthesis line
Physiological tension zone
GK / MAXFAC
SDM DHARWAD
www.indiandentalacademy.com
No post op IMF

67. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
Open REDUCTION
Miniplate Osteosynthesis (Champy)
Based on
Mathematical model of mandible
Reactive bite forces
Strains created by muscular activity
Flexion - upper part of mandible
GK / MAXFAC
SDM DHARWAD
www.indiandentalacademy.com
Torsion - canine

68. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
Open REDUCTION
Miniplate Osteosynthesis (Champy)
Ideal line of osteosynthesis
Anatomy of mandilbe
Location of teeth apices
Cortical thickness
Line of tension at base of alveolus
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

69. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
OPEN REDUCTION
Miniplate Osteosynthesis (Champy)
Requirements of miniplate
Neutralize Induced tension / torsion forces
Behind mental foramen 1 plate subapically
Anterior to mental foramen 2 plates
Higher torsion forces
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

70. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
OPEN REDUCTION Miniplate Osteosynthesis
Clinical applications
Symphysis/Parasymphysis/body/angle
G.A - Nasal Intubation
Eylets / Archbars Temp IMF
Intraoral Approach
Exposure of fracture site(s)
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

71. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
OPEN REDUCTION Miniplate Osteosynthesis
Clinical applications
Curretage (haematoma)
Reduction of Fracture
Temporary Imobilization (IMF)
Mini plate application & fixation
Debridiment & removal of IMF
Recheck occlusion & Clossure
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

72. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
OPEN REDUCTION Miniplate Osteosynthesis
Clinical applications
Precautions
Protect mental nerve and soft tissues
Position plates below apices of teeth
Longer plates for comminuted #s
Release IMF & recheck occlusion
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

73. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
OPEN REDUCTION Lag Screw Fixation
Principle
Axial tensile stress of screw transformed to
Compressive stress on fracture site
Near Fragment supported by screw head
Distant fragment pulled by screw thread
Axial compression of # site
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

74. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES Management
OPEN REDUCTION Lag Screw Fixation
Indiactions : # symphysis / body / angle
Requirements: reliable cortical anchoring
strong cortical surface
Limitations: # localization
soft tissue & nerves
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

75. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Angle of mandible
Extraoral:Gonion
Intraoral: Junction of alveolar bone and ramus
In fracture of angle mandible
Greater fragment :teeth bearing segment
Lesser fragment: ramus
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

76. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Fracture of angle mandible
Change in direction of grains
Impacted / partially errupted 3rd molars
Pterygo masseteric sling
“Direction of fracture line determines
degree of displacement of ramus”
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

77. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Fracture of angle mandible
Displacement of Ramus
(post edentulous fragment)
Favourable: Minimal displacement
Unfavourable: Gross displacement
Viewed from side: Horizontal
Viewed from above: Vertical
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

78. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Fracture of angle mandible
Displacement of Ramus: muscular pull
Elevators: upward forward medial
Deprsessors: downwards backwards
Masseter / Medial pterygoid
Temporalis / mylohyoid
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

79. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Edentulous mandibles
Mostly simple #s
Usually heals with out complications
Displacement of # fragments variable
Classification(Luhr et al)
according to height of bone
Class 1 : 16 - 20mm
Class2 : 11- 15mm
Class3 : less than 10mm
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

80. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Edentulous mandibles Treatment Methods
Closed Reduction & Fixation
Intra oral apliances: gunning splints
dentures trimmed & relined
(stabilized with Circumfrential wiring)
Extraoral pin fixation
Immobilization period 4-6 weeks
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

81. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Edentulous mandibles Treatment Methods
Open reduction & fixation
Intraosseous wiring
Primary rib grafting
Reconstruction plate
In bilateral body #s ( bucket handle # )
Precautions
Avoid excessive periosteal stripping
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GK / MAXFAC
SDM DHARWAD

82. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Always located behind & above lingula
Difficult to diagnose
Treatment Methods differ
- access
- growth centre
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GK / MAXFAC
SDM DHARWAD

83. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
mecanism of fracture simplifies diagnosis
2/3rds associated with other fractures
Indirect injury - chin
Direct injury - Zygoma
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

84. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Classification
Clinical features
Radiolodical investigations
Treatment options
Complications
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

85. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Theraputic & Prognostic indicators
Height
Direction of fracture line
Degree of displacement
Classification (height)
Intracapsular
Extracapsular(sub condylar):
High Low Base
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

86. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Classification
Base Intracapsular
Extracapsular(sub condylar): High, Low, Base
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

87. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Clinial Diagnosis
Height of fracture
Degree of dislocation of fragment
Fracture gap at attachment of
Lateral Pterygoid
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GK / MAXFAC
SDM DHARWAD

88. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Clinical features
Intracapsular fractures(above lateral pterygoid)
Tenderness in articular region
Painful limitation in mouth opening
Occlusal derangement –
posturing and deviation to healthy side
(due to edema & pain)
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

89. MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Clinical features
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

90. www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

91. MAXILLOFACIAL INJURIES
Classification :Anatomical site
Etiology
Force >>> Injury
Force=Kinetic energy (K) K=MV2
www.indiandentalacademy.com
GK / MAXFAC
SDM DHARWAD

92. Thank you
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