Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Mandible is single continuous bone from the

condyle to the other condyle.

pterygoid plates are unpaired bone.

We have paired and unpaired bones in the skull.

RTA: road traffic accident (major cause of

fractures to all of body + face)

We have to know cause of fracture; like in case it

was a domestic violence we should report.

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Deep lesion inside bone (bone becomes empty + thinning of cortical bone and border of the mandible
leading therefore to fractures)

Osteoporosis: patients are in high risk of fracture.

Simple fracture: fracture is still inside the bone and no communication with surroundings (skin extra-
orally or mucosa intra-orally)

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

comminuted: no fragments of bone

Impacted: fracture feyte bi ba3da; mostly

happens in cases of le fort maxillary
fractures (hit in maxilla and maxilla
breaks and enters inside itself)

Green stick: breakage but bone loss didn’t

reach its continuity (‫ )شعر مش كسر‬not
reaching the border of bone.

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Fracture lines.

Arch bar used to make fixation between

maxillary and mandible for stabilization
and movement prevention.

1. Condylar fracture
2. Coronoid fracture
3. Ramus fracture
4. Angular fracture
5. Body fracture
6. Symphyseal fracture
7. Para-symphysial on premolar
area

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Different fracture types in mandible.

This is the thing that detects if the

patient needs surgery or no.

Unfavorable: fracture line is

affected by contraction of muscles
and need surgery intervention. (This
fracture should be fixed)

In case muscle contractions in the

area of fracture pushes the bone
fragment towards each other =
favorable fracture (already fixed
and no need for surgery
interference)

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Direction of body is outward and ramus inward leading to movement

of fracture area (and it should be fixed) so it is unfavorable fracture
and needs surgery intervention.

parasymphysial fracture

Body fracture

Gun -hot wound fracture

Pathological fracture

Discontinuity in mandible means fracture

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Mandibular angular
fracture

If line of fracture is between these two

muscles, no need for surgery intervention
since favorable fracture

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Upward picture: supra-hyoid muscles pull mandible

downward and muscles of mastication pulls it
downward.

According to location of line of fracture, we detect if it is a

favorable or non-favorable fracture.

In case of fracture in edentulous patient; there is

no occlusal stops for fixation (mandible will be
displaced)

If patient has posterior stops, then it can be

fixated.

Usually tooth in line of fracture should be

removed (if line of fracture passes through
tooth root, it becomes non-vital and become a
source of infection) and it can cause mal-union
of the 2 fragmented parts.

If the fracture line passes through the tooth

crown, the tooth can be saved.

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

In cases of simple fractures (if it is not

extended intra-orally or extra-orally)

Trauma on premolar (fracture in para-

symphyseal area in the same side and condyle
fracture in other side)

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

CT scan showing a fractured condyle.

(unfavorable fracture since muscles are pushing

it medially)

1st line of treatment is first aid.

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Especially if we have bilateral symphyseal fracture (in

premolar area), this makes genio-glossal muscle pull
the fracture side downwards = tongue retracts
posteriorly and cause airway blockage.

tooth aspired inside the lungs

tooth fractured inside the lip

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Don’t put patient in supine position (in order

for vomit or blood to be ejected outside if he
was put on his side)

Chin-lift: thumb on oncisal edge of mandibular

teeth and lift chin and pull it forward in order
to open airway.

Jaw thrust: both hands along ascending

ramus of mandible and fingers behind inferior
border of the mandible and thumbs on teeth
then pull gently forward in order to open the
airway.

Tracheostomy: in case of complete airway

obstruction.

Normal patient: volume of blood is 7% of his

weight.

If patient is 70 kg then he has 5 L of blood.

This patient when having 20% loss of blood,

blood pressure will depress significantly =
cardiovascular system in order to compensate
for this drop increase respiratory rate.

In case blood loss was over 40%, patient might

have cardiac arrest

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

In elder patients, 10 to 15% blood loss might lead to significant blood pressure drop as well.

Blood transfusion to supply them with blood

since they lost a lot of blood.

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

Trauma: can cause to enter in shock state

(hypovolemic neurogenic shock)

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Surgery 1st session (3-2-2022) 5th Year Sara Atiya

In case of open wound: high risk of infection.

Ceparon: cyphalosporin antibiotics

Fear of any fracture in spinal cord (we should

handle the neck properly with neck collar to avoid
compression on cervical spines and cause paralysis
for the patient)

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