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FRACTURAS
MANDIBULARES
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36%
2%
25%
20%
3%
14%
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Mandibular Stresses
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Bite
Force
Muscle pull
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Tension band (monocortical), Champy, MMF or interdental wiring
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monocortical
bicortical
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Tension band (monocortical), Champy, MMF or interdental wiring
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Anatomy Principles, BoneHealing, SurgicalApproaches and DCP
Principles
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Objectives
Review anatomy
Discuss bone healing
Explore principles of stable internalfixation
Delineate load sharing vs load bearing
osteosynthesis Review mandibular surgical approaches
Discuss proper plating techniques
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Adult panorex
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Child Panorex
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Bone Healing
Primary Secondary
No callus Callus
Direct bridging osteons
Bony deposition
Remodeling
Fracture hematoma
Progenitor deposition
Differentiation
Reduced risk for fibrous
malunion
Elevated risk for fibrous
malunion
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Bone Healing
Primary
Adequate stability
Secondary
Inadequate stability
No callus Callus
Direct bridging osteons
Bony deposition
Remodeling
Fracture hematoma
Progenitor deposition
Differentiation
Reduced risk for fibrous
malunion
Elevated risk for fibrous
malunion
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Bone Healing
How do we assure stability of fracture line?
1. Control of tension zone.
2. Fixation of compression zone.
3. Achieving appropriate occlusalrelationship.
4. All of the above.
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Bone Healing
How do we assure stability of fracture line?
1. Control of tension zone.
2. Fixation of compression zone.
3. Achieving appropriate occlusalrelationship.
4. All of the above.
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Control of mandibular stresses
Zone of Tension
Zone of Compression
Load Sharing Fixation
Load Bearing Fixation
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Load sharing vs Load bearingAbsolute bone-bone
contact in fracture line
Gaps in bone-bone
interface
Plate distributes
mandibular forces to
BONE
Miniplates adequate
Mandibular forces borne
by PLATE
Need strong plate
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Approaches
MMF Arch bars Ivy loops Circumandibularwires
Circumpiriform wires Ernst ligatures MMF screws
ORIF condyle
Endoscopic assist Open
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Approaches
Intraoral/buccalsulcus incision
Avoidance/preservation of mental nerve
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Approaches
ORIF Risdon incision
Extended risdon
Transbuccal trocarwith intraoralincision
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Approaches
MMF Arch bars
Ivy loops
ORIF Risdon incision
Intraoral/buccalsulcus incision
External fixator
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Case examples
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Naso-Orbital-Ethmoid Fracture
Central midline impact
Nasal fracture
Medial orbital fracture of medial canthaltendon bearing area
Ethmoid fracture
Telecanthus
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NOE
Type 1: Large attached fragment to MCTand stable central segment
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NOE
Type 2: Large attached fragment to MCTand cominuted central segment
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NOE
Type 3: Comminuted fragments withunattached MCT and comminuted centralsegment
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Fixation
Type 1 and some type 2 : miniplatereduction 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
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Thank you
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Difficult Cases