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Management of Mandibular Fracture

Management of Mandibular Fracture

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Published by: Khalid Mahmud Arifin on Jun 27, 2008
Copyright:Attribution Non-commercial

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02/20/2013

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1) Diagnosis and evaluation of patient:
a) History taking:
Accurate detail and proper history of patient should be taken.
If the patient is unable to give statement then the same should be recorded fromaccompanying person, relative, friends or police officers.
If will reveal about how the injury occurred, the type of injury and the severityof the injury.
b) General Examination:
It should be carried out to look for any serious injury elsewhere in the body sothat the appropriate specialist could be consulted.
Inspection and palpation of head for any soft tissue as well as bone injury.
Inspection and palpation of chest and abdomen for any injury.
c) Regional Examination:
The mouth and the face should be carefully cleaned for a proper examination.
Extra oral :-Inspection - Palpation
Intra oral- Inspection - Palpation
d) Radiological examination:
Extra-oral Radiograph:
P/A view of mandible in open mouth position
Right and left lateral oblique view.
X-ray for TMJ in both opened and closed mouth position
OPG.
Occlusal vies
2) Definitive treatment:
(i)
Conservative treatment:
(When only fracture line seen but no displacement thenconservative Rx done).a) Control of pain- A patient of fracture of mandible experiences extreme degreeof pain and may go into shock because of service into lerable pain so IVDiazepam can be given in the does of 10 mg combined with (15-30)mg pentazocine as analgesics.1
 
 b) Control of infection- Prevention of infection is of outmost importance so,antibiotics should be prescribed.c) Temporary stabilization of fractured part temporary splinting of the fracturedfragments with the help of barrel bandage. Temporary stabilization in the form of horizontal wiring is and effective procedure.d) Soft diets.e) Oral hygiene Instructions:f) Advice to the patient that he / she shouldn’t move the jaw vigorously.g) Follow-up.ii)
Active treatment / principles of treatment:
(if displacement occur then activeRx. done).
Reduction:
It is the process of bringing the fractured fragments into alignmentnormal Position.
Types:Closed reduction:
It is usually done in simple fracture.1.Whenever closed reduction is possible the risk of subsequent infection of thefracture is negligible.2.Precise anatomical reduction is not necessary in fracture of denture bearingarea.3.Pulls or manipulate the bone under the intact skin until the fracture is in proper position.
Open reduction:
1.If tooth remains undamaged, potentially functional should be retained withantibiotic administration.2.If tooth is damaged & not functional.
Fixation:
It is the procedure by which the fractured bone ends are fixed in reduced position.a)Indirect fixation by IMF b)Direct fixation by bone plate, screws.2
 
Immobilization:
The reduced and fixed fragments of the bone are immobilized for certain periodfor healing to occur.Fixation and immobilization are achieved together by the means of IMF or withthe help of bone plates and screws.
Rehabilitation / Physiotherapy:
Treatment plan:
IntracapsularExtracapsulaChildrenUnilateral:Activemovement No.IMFBilateral Activemovement No.IMFUnilateral: IMF (7-10) Days. (Notnecessary if notdisplaced)Followed by activemovement.Bilateral: IMF (7-10) Days, (Notnecessary if notdisplacedFollowed byactive movement.AdultOcclusion OK  No. IMFPainful JointIMF-2 weeks.IMF(3-4) weeksIMF only atnight withelastics-4 WeeksIMF-4 weeks openSOS.IMF (4-6) weeksOpen SOS.Intermittent IMF:48 hours IMFthen open then 24hours IMF.
TIME OF IMMOBILIZATION OF FRACTURED MANDIBLE
Period of immobilization depends upon the site of fracture, presence or retained teeth infracture line, age of patient and presence and absence of infection.A simple guide to the time of immobilization for the fracture of tooth bearing area of thelower jaw is follows:Young adult with fracture of the angle receiving early treatment in which tooth removedfor the fracture line = 3 weeks.3

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