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Mandibular Fractures

Mandibular Fractures

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Published by Rohan R. Rao

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Published by: Rohan R. Rao on Jul 02, 2007
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10/30/2014

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Mandibular fractures
 Introduction
 Aetiology
Classification
Surgical Anatomy
 Applied Anatomy
Clinical examination
 Radiology
 Preliminary treatment 
 Fractures of dentulous mandibles
 Fractures of edentulous mandibles
 Fractures of condylar regions
 Fracutres of mandible in children
 Postoperative crae
Complications
 Fractures with gross comminution of bone and loss of hard and soft tissue
Introduction
The first description of mandible fractures was as early as 1650 BC, when an Egyptian papyrusdescribed the examination, diagnosis, and treatment of mandible fractures. Many patients either werenot treated properly or received no treatment and subsequently died.A broken jaw (or mandibular fracture) is a common facial injury. Only the nose is broken morefrequently. A broken jaw is the tenth most common fractured bone in the human body. Fractures(these are breaks in the bone) are generally the result of a direct force or trauma to the jawbone.Men are about 3 times more likely than women to sustain a broken jaw. Those aged 20-29 years arethe most common group affected.Broadly divided into:Fractures with no gross comminution of bone and without soft tissue/hard tissue loss.Fractures with gross comminution of bone and significant hard and soft tissue loss.
Aetiology
Road injuries
Interpersonal violence
Falls
 
Sporting injuries
Industrial trauma
Missile injuries
Gunshot wounds
Pathological fracturesThe primary causes of mandible fractures are vehicular accidents and assaults. These vary accordingto the area in which the survey was taken and the socioeconomic and ethnic status of the community.Other significant causes are falls and sports injuries. In a large retrospective study of 2137 patientswith mandibular fractures, Ellis et al reported that 43% were caused by vehicular accidents, 34% byassaults, 7% were work related, 7% occurred as the result of a fall, 4% occurred in sportingaccidents, and the remainder had miscellaneous causes. Vaillant and Benoist described 14 cases of gunshot injuries to the mandible. Patients were aged 6-68 years. Two children were victims of accidents, and the adults were either suicide or assault victims.
Classification
According to
Type of fracture
 Simple or closed 
: Fracture that does not produce a wound open to the external, whether it be through the skin, mucosa, or periodontal membrane .
Compound or open
: Fracture in which an external wound, involving skin, mucosa, or  periodontal membrane, communicates with the break in the bone
Comminuted 
: Fracture in which the bone is splintered or crushed
Greenstick 
: Fracture in which one cortex of the bone is broken and the other cortex is bent
 Pathologic
: Fracture occurring from mild injury because of preexisting bone disease
 Multiple
: Variety in which two or more lines of fracture on the same bone are notcommunicating with one another 
 Impacted 
: Fracture in which one fragment is driven firmly into the other 
 Atrophi 
c
: Fracture resulting from severe atrophy of the bone, as in edentulous mandibles
 Indirect 
: Fracture at a point distant from the site of injury
Complicated or complex 
: Fracture in which considerable injury to the adjacent soft tissuesor adjacent parts occurs; may be simple or compound
 
Site of fracture
 Symphysis
: Fracture in the region of the central incisors that runs from the alveolar processthrough the inferior border of the mandible
 Parasymphyseal 
: Fractures occurring within the boundaries of vertical lines distal to thecanine teeth
 Body
: From the distal symphysis to a line coinciding with the alveolar border of themasseter muscle (usually including the third molar)
 Angle
: Triangular region bounded by the anterior border of the masseter muscle to the posterosuperior attachment of the masseter 
 Ramus
: Bounded by the superior aspect of the angle to two lines forming an apex at thesigmoid notch
Condylar process
: Area of the condylar process superior to the ramus region
Coronoid process
: Includes the coronoid process of the mandible superior to the ramusregion
 Alveolar process
: Region that normally contains teeth

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