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2.
3.
4.
5.
2.
3.
4.
Muscles of Mastication:
These are the muscles which:
1. Inserted to the ramus of mandible.
2. Supplied by mandibular nerve.
3. Developed from first pharyngeal arch.
4. Helps in mastication and speech.
It includes:
1. Masseter.
2. Temporalis.
3. Lateral pterygoid.
4. Medial pterygoid.
Masseter: It is a quadrilateral muscle of mastication.
Origin:
1. From lower border and outer surface of zygomatic process of
temporal bone.
2. Lower border of temporal process of zygomatic bone.
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2.
3.
Maintains
occlusal
position
of
mandible.
4.
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11
2.
3.
4.
12
a.
b.
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Geography.
Social trends.
Seasons.
22%
Condyle
29%
Angle
25%
Symphysis -
16%
Ramus
4%
Coronoid
1%
Parasymphysis -
16%
Dentoalveolar -
3%
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Classification
There are several ways to classify the mandibular fractures.
i.
General classification.
ii.
Anatomical locations.
iii.
iv.
Completeness.
v.
vi.
Number of fragments.
vii.
viii.
ix.
x.
xi.
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disorders
Hyperparathyroidism
or
postmenopausal osteoporosis.
ii.
iii.
b.
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2.
Anatomical Location
Single unilateral.
iii.
Double unilateral.
iv.
Bilateral.
v.
Multiple.
Direct fractures.
iii.
Indirect (countercoup)fractures.
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4. Completeness
Complete and incomplete fractures.
5. Depending on the mechanism
ii.
Avulsion fracture.
iii.
Bending fracture.
iv.
Burst fracture.
v.
Countercoup fracture.
vi.
Torsional fracture.
6. Number of Fragments:
Single, multiple, comminuted, etc.
7. Involvement of the integument
Closed or open fracture.
Grades of severity I-V
8. Shape or area of the Fracture
Transverse, oblique, butterfly, oblique surfaced.
9. According to the Direction of Fracture and Favourability for
treatment
b. Horizontally favourable fracture.
c. Horizontally unfavourable fracture.
d. Vertically favourable fracture.
e. Vertically unfavourable fracture.
This classification is aimed toward the angle fractures. Here,
the direction of fracture line is important for resisting the muscle
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pull. When the muscle pull resists the displacement of the fragments
then the fracture line is considered as favourable. If the muscle pull
distracts the fragments away from each other, resulting in
displacement, then the fracture line is considered as unfavourable.
a.
b.
c.
d.
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If
favourable,
ii.
Class III When both the fragments on each side of the fracture
line are edentulous.
i.
ii.
iii.
11.
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L5: Supra-angular
L6: Condyle
L7: Coronoid.
L8: Alveolar process
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ii.
iii.
iv.
v.
No bone grafting.
Reduction by manipulation.
ii.
Reduction by traction.
No surgical intervention is needed in closed reduction.
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Inexpensive.
Disadvantages:
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Myofibrosis.
Weight loss.
or by traction method:
i.
for
grasping
the
fragments
are
available
Reduction by traction:
a. Intraoral traction method.
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reduction
(surgical
reduction
allows
visual
Normal nutrition.
Bone
visualization.
fragments
re-approximated
exactly
by
patients).
Decreased
patient
discomfort,
greater
patient
satisfaction.
Less myoatrophy.
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Disadvantages:
Prolonged anaesthesia.
Expensive hardware.
in
their
normal
anatomical
relationship
to
prevent
Immobilization:
During this phase, the fixation device is retained to stabilize
the reduced fragments into their normal anatomical position, until
clinical bony union takes place. The fixation device is utilized for a
particular
period
to
immobilize
the
fractured
fragments.
involved.
For
maxillary
fractures
to
weeks
of
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Essigs wiring.
ii.
Gilmers wiring.
iii.
Risdons wiring.
iv.
v.
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2.
3.
Acrylic splints:
1. Lateral compression splint.
2. Gunning splint.
Wiring procedure:
1. Prealveolar wiring procedure.
2. Circumferential (circummandibular) wiring procedure.
Anatomy of Biomechanics of the Mandible:
Champs ideal osteosynthesis lines:
In every mandibular fracture, the forces of mastication
produce tension forces at the upper border and compression forces at
the lower border. Therefore, distraction of the fractured fragments
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will be seen at the alveolar crest region. In the canine region, there
are overlapping tensile and compressive loads in both the directions.
Besides this torsional forces are also significant.
Internal fixation by means of bone plate osteosynthesis:
The direct internal fixation of the fractured fragments can be
carried out by bone plate osteosynthesis method. It either totally
eliminates the need of IMF or minimizes the period of IMF.
Indications:
1. Cases where there is absolute contraindications to IMF, i.e. in
epileptics,
mentally
retarded
uncooperative
patients,
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a.
b.
c.
d.
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inner plate of bone. When tightened head of the screw engages in the
outer plates and the oblique fracture is compressed.
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References:
Oral and Maxillofacial Trauma Fonseca, Vol. 1, 2 nd
1)
edition.
2)
3)
4)
5)
6)
7)
Banks.
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