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INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

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MAXILLOFACIAL INJURIES MANAGEMENT Primary management (ABCDE) Neurological assessment (GCS) Control of pain analgesics Control of infection antibiotics Surgical planning www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management - immediate - definitive • Complications www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy

Curved bone Thickness of cortices Neurovascular bundle Dentition Attachment of Muscles www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy

Muscle attachments: Depressors digastric geniohyoid Elevators temporalis masseter medial pterygoid www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy Areas of weakness •teeth •foramen •alveolar bone •angle •ramus •Condyle

Blood supply Nerve supply www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES •Applied surgical anatomy •Classification •Clinical features •Radiological features •Management - immediate - definitive •Complications www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification

- Anatomical location - Relation to site of injury - Condition of fracture fragments - Type of displacement (angle) - # with reference to dentition www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Anatomical site

•symphysis •parasymphysis •body •angle •ramus •condyle •coronoidwww.indiandentalacademy.com

GK / MAXFAC SDM DHARWAD


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification - Anatomical location - Relation to site of injury - Condition of fracture fragments - Type of displacement (angle) - # with reference to dentition www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Relation to site of injury -Direct -Indirect

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MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification - Anatomical location - Relation to site of injury - Condition of fracture fragments - Type of displacement (angle) - # with reference to dentition www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Condition of fractured fragments Green Stick Simple Compound Comminuted www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification

- Anatomical location - Relation to site of injury - Condition of fracture fragments - Type of displacement (angle) - # with reference to dentition www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification: type of displacement Angle of mandible Extraoral:Gonion Intraoral: Junction of alveolar bone and ramus

Fracture of angle mandible Greater fragment :teeth bearing segment Lesser fragment: ramus www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Type of displacement (angle) favorable / unfavorable horizontal - vertical

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GK / MAXFAC SDM DHARWAD


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES

Classificaton Fracture angle of mandible Displacement of Ramus (post edentulous fragment) Favorable: Minimal displacement Unfavorable: Gross displacement Viewed from side: Horizontal Viewed from www.indiandentalacademy.com above: Vertical


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification - Anatomical location - Relation to site of injury - Condition of fracture fragments - Type of displacement (angle) - # with reference to dentition www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification # with reference to dentition Dentulous Child Adult Edentulous Dentulous jaw with a posterior edentulous fragment

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MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Classification Kazanzian & Converse Class I Teeth on both segments Class II teeth on one segment Class III Edentulous

Rowe & Killey #s involving the basal bone #s not involving the basal bone www.indiandentalacademy.com favorable / unfavorable


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy Classification Clinical features Radiological features Management immediate definitive Complications www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Clinical Features Inspection Hemorrhage Pain Swelling Altered occlusion Sublingual echymosis Halitosis Paraesthesia www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Clinical Features Palpation Confirm inspectory findings Tenderness Fracture line/step Crepitation Paraesthesia Abnormal mobility www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES

Applied surgical anatomy Classification Clinical features Radiological features Management immediate definitive Complications www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Radiographic features OPG / Lateral oblique P A mandible Intra oral occlusal view

Confirms Site and severity of # Direction & displacement of # Condition of teeth in line of # Presence of bony pathology www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Applied surgical anatomy Classification Clinical features Radiological features Management immediate definitive Complications www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Objectives RESTORE FORM & FUNCTION Remember A B C D E Precise diagnosis Early reduction Adequate fixation and immobilization Rehabilitation / restoration of function www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management

Immediate (Primary) ABCDE Temp immobilization Analgesics Antibiotics Diet & OHI www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Definitive Reduction Fixation Immobilization Rehabilitation www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management

REDUCTION Closed Advantages No need for a G.A Can be used in comminuted # Continuity defects ( gun shot injuries)

Disadvantages Accuracy of reduction ambiguous Poor fracture alignment www.indiandentalacademy.com Inadequate reduction


MAXILLOFACIAL INJURIES

MANDIBULAR FRACTURES Management CLOSED REDUCTION

AIM : Immobilization (IMF) •Ivy eyelet wiring •Direct wiring

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MAXILLOFACIAL INJURIES

MANDIBULAR FRACTURES Management CLOSED REDUCTION AIM : Immobilization (IMF) •Arch Bar Wiring

•Extra oral pin fixation www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management REDUCTION Open Exposure of fracture skin / mucosa Direct reduction and fixation Transoseous Wiring Plate & Screw Osteosynthesis

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MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Plate & Screw Osteosynthesis (Titanium/Stainless steel) Compression plates Mini plates Lag Screw www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management REDUCTION Open Advantages Accurate reduction & fixation Alignment under direct visualization

Disadvantages Need for a G.A & Hospitalization www.indiandentalacademy.com Expenses !!!


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Open REDUCTION Miniplate Osteosynthesis (Champy) Small malleable plate( 2 - 2.5 mm thickness) Trans oral approach No post op IMF

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MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Miniplate Osteosynthesis

Symphysis/Parasymphysis/body/angle Eyelets / Arch bars Temp IMF Intraoral Approach Exposure of fracture site(s) Curettage (haematoma) Reduction of Fracture Temporary Immobilization (IMF) www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management OPEN REDUCTION Miniplate Osteosynthesis

Clinical applications

Mini plate application & fixation Debridement & removal of IMF Recheck occlusion & Closure

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MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES • Applied surgical anatomy • Classification • Clinical features • Radiological features • Management - immediate - definitive • Complications www.indiandentalacademy.com


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MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Edentulous mandibles Mostly simple #s Usually heals with out complications Displacement of # fragments variable Classification(Luhr et al) according to height of bone Class 1 : 16 - 20mm Class2 : 11- 15mm www.indiandentalacademy.com Class3 : less than 10mm


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Edentulous mandibles Treatment Methods Closed Reduction & Fixation Intra oral appliances: gunning splints dentures trimmed & relined (stabilized with Circumferential wiring) Extraoral pin fixation Immobilization period 4-6 weeks www.indiandentalacademy.com


MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Management Edentulous mandibles Treatment Methods Open reduction & fixation Intraosseous wiring Primary rib grafting Reconstruction plate In bilateral body #s ( bucket handle # ) Precautions Avoid excessivewww.indiandentalacademy.com periosteal stripping


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Max fac inj manag/ dental implant courses by Indian dental academy