Mandible Fractures

Discuss unfavorable and favorable mandible fractures.  Where do the pterygoids attach?  What do they do?

Describe the distribution of mandible fractures by site.

Review dental anatomy. Discuss terminology and arrangement of primary and permanent dentition.

Give us the angle classification of occlusion.

What are Champy’s lines and why are they important in ORIF of mandible fractures?

How would you manage teeth in the line of fracture?

Reference(s):

Fearon, J. A. (2017). Discussion: Spring-Assisted Cranioplasty for the Correction of Nonsyndromic Scaphocephaly: A Quantitative Analysis of 100 Consecutive Cases. Plastic and Reconstructive Surgery, 140(1), 135–136.

What is the rate of lingual injury associated with mandible fractures? What about of alveolar nerve?

What should you look for on physical exam?

What imaging would you order to work up a mandible fracture?

Reference(s):

Wilson, I. F., Lokeh, A., Benjamin, C. I., Hilger, P. A., Hamlar, D. D., Ondrey, F. G., … Schubert, W. (2001). Prospective comparison of panoramic tomography (zonography) and helical computed tomography in the diagnosis and operative management of mandibular fractures. Plastic and Reconstructive Surgery, 107(6), 1369–1375.

Gelesko, S., Markiewicz, M. R., & Bell, R. B. (2013). Responsible and prudent imaging in the diagnosis and management of facial fractures. Oral and Maxillofacial Surgery Clinics of North America, 25(4), 545–560.

Review the important technical aspects of mandible fracture treatment.

Reference(s):

Ellis, E. 3rd, & Miles, B. A. (2007). Fractures of the mandible: a technical perspective. Plastic and Reconstructive Surgery, 120(7 Suppl 2), 76S–89S.

Discuss the management of subcondylar neck fractures.

Reference(s):

Hackenberg, B., Lee, C., & Caterson, E. J. (2014). Management of subcondylar mandible fractures in the adult patient. The Journal of Craniofacial Surgery, 25(1), 166–171.

Ellis, E. 3rd, Kellman, R. M., & Vural, E. (2012). Subcondylar fractures. Facial Plastic Surgery Clinics of North America, 20(3), 365–382.

In which situation would you consider a Joe Hall Morris device application? How do you put one on?

What are the indications for lag screw. Technique?

Reference(s):

Ellis, E. 3rd. (2012). Is lag screw fixation superior to plate fixation to treat fractures of the mandibular symphysis? Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 70(4), 875–882.

Agnihotri, A., Prabhu, S., & Thomas, S. (2014). A comparative analysis of the efficacy of cortical screws as lag screws and miniplates for internal fixation of mandibular symphyseal region fractures: a randomized prospective study. International Journal of Oral and Maxillofacial Surgery, 43(1), 22–28.

What methodologies are available for the edentulous mandible?

Reference(s):

Clayman, L., & Rossi, E. (2012). Fixation of atrophic edentulous mandible fractures by bone plating at the inferior border. Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 70(4), 883–889.

Angle fractures: What are the various approaches for repair?

Reference(s):

Ellis, E. 3rd. (2010). A prospective study of 3 treatment methods for isolated fractures of the mandibular angle. Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 68(11), 2743–2754.

What are indications for opening a condyle? What about relative indications?

Does a delay in treatment of mandible fractures result in an increased incidence of complications?

When are postoperative antibiotics indicated?

Reference(s):

Miles, B. A., Potter, J. K., & Ellis, E. 3rd. (2006). The efficacy of postoperative antibiotic regimens in the open treatment of mandibular fractures: a prospective randomized trial. Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 64(4), 576–582.

Review post operative complications of mandible fractures.

Reference(s):

Hernandez Rosa, J., Villanueva, N. L., Sanati-Mehrizy, P., Factor, S. H., & Taub, P. J. (2016). Review of Maxillofacial Hardware Complications and Indications for Salvage. Craniomaxillofacial Trauma & Reconstruction, 9(2), 134–140.

Pediatric mandible fractures…should they be treated differently?