FRACTURAS MANDIBULARES

36%

2%

25%
14% 3% 20%

Mandibular Stresses

Muscle pull

Bite Force

Tension band (monocortical), Champy, MMF or interdental wiring

monocortical bicortical

Tension band (monocortical), Champy, MMF or interdental wiring

Anatomy Principles, Bone Healing, Surgical Approaches and DCP Principles

Review anatomy Discuss bone healing Explore principles of stable internal fixation Delineate load sharing vs load bearing osteosynthesis Review mandibular surgical approaches Discuss proper plating techniques

Objectives

Adult panorex

Child Panorex

Bone Healing
Primary No callus Direct bridging osteons Bony deposition Remodeling Reduced risk for fibrous malunion Secondary Callus Fracture hematoma Progenitor deposition Differentiation Elevated risk for fibrous malunion

Bone Healing
Primary Adequate stability No callus Direct bridging osteons Bony deposition Remodeling Reduced risk for fibrous malunion Secondary Inadequate stability Callus Fracture hematoma Progenitor deposition Differentiation Elevated risk for fibrous malunion

How do we assure stability of fracture line? 1. Control of tension zone. 2. Fixation of compression zone. 3. Achieving appropriate occlusal relationship. 4. All of the above.

Bone Healing

How do we assure stability of fracture line? 1. Control of tension zone. 2. Fixation of compression zone. 3. Achieving appropriate occlusal relationship. 4. All of the above.

Bone Healing

Zone of Tension Zone of Compression Load Sharing Fixation Load Bearing Fixation

Control of mandibular stresses

Load sharing Absolute bone-bone vs Load Gaps in bearing bone-bone

contact in fracture line interface

Plate distributes mandibular forces to BONE Miniplates adequate

Mandibular forces borne by PLATE

Need strong plate

Approaches
MMF
Arch bars Ivy loops Circumandibular wires Circumpiriform wires Ernst ligatures MMF screws Endoscopic assist Open

ORIF condyle

Approaches
Intraoral/buccal sulcus incision Avoidance/preservatio n of mental nerve

Approaches
ORIF
Risdon incision Extended risdon Transbuccal trocar with intraoral incision

Approaches

MMF
Arch bars Ivy loops

ORIF
Risdon incision Intraoral/buccal sulcus incision External fixator

Case examples

Central midline impact Nasal fracture Medial orbital fracture of medial canthal tendon bearing area Ethmoid fracture Telecanthus

Naso-Orbital-Ethmoid Fracture

Type 1: Large attached fragment to MCT and stable central segment

NOE

Type 2: Large attached fragment to MCT and cominuted central segment

NOE

Type 3: Comminuted fragments with unattached MCT and comminuted central segment

NOE

Type 1 and some type 2 : miniplate reduction of large fragment with attached MCT Type 3 or bilateral: Transnasal wiring

(difficult)
Anterior displacement of tendon and soft tissue Usually err on placing canthus too low

Fixation

Thank you

Difficult Cases