36. MANDIBULAR FRACTURES CLASSIFICATION

what is the etiology of mandibular fractures?

mostly affects men from 20-30y/o

industry- manufacturing/agricultural accidents

non-industrial- domestic/traffic accidents

deliberate- suicide/war injuries

what is the classification of mandibular fractures?

1. etiology

2. mechanism

3. fragments and fracture character

4. dislocation of fragments

5. relation of fracture to soft tissue

6. occlusion

7. combined

8. combined traumatic brain injury

9. depending on localisation within the mandible

what are the types of mandibular fractures according to etiology?

traumatic external force

pathological (tumors/cysts/osteomyelitis)

what are the types of mandibular fracture according to mechanism?

direct (area where force is applied will fracture)

indirect (fracture away from where force is applied)

what are the types of mandibular fracture according to fragments and fracture character?

incomplete (only cortical bone plate affected)

single (2 fracture fragments)

comminuted (3 fracture fragments)

fragmented (multiple fragments)

what are the types of mandibular fracture according to dislocation of fragments?

favourable (fracture line and muscle pull resist being displaced)

unfavourable (fracture line and muscle pull cause displacement)

what are the types of mandibular fracture according to relation of fracture to soft tissue?

closed (soft tissue intact)

open (damage to soft tissue)

what are the types of mandibular fracture according to occlusion?

occlusion is violated

occlusion is not violated

what are the types of mandibular fracture according to localisation within mandible?

condylar angle

ramus

angle

body

symphyseal

alveolar

coronoid process

what are the types of fractures according to bone involvement?

combined:

A- to both jaws

B- 1 jaw and another bone (e.g. zygoma)

whats the last classification?

traumatic brain injury + co-ocurring jawbone fracture

what are the pathognomic signs of mandibular fractures?

bone integrity is violated

pathlogical mobility

bone crunches/has crepitus

what are the secondary symptoms of mandibular fractures?

pain

facial deformity

swelling

occlusal violations

oral/nasal bleeding

reduced mouth opening

impaired speech and breathing

THESE SYMPTOMS ALONE DONT CONFIRM THE FRACTURE

what are the diagnostic steps for mandibular fractures?

1. anamnesis

2. clinical signs

3. clinical evaluation

4. radiographs/imaging

what should be established in the anamnesis?

Time + Place of trauma

was first aid given?

did the patient lose consciousness?

subjective complaints (may be exaggerated or underplayed)

general health - ABCs, bleeding, vision (may indicated head trauma)

what are the clinical signs for mandibular fractures?

facial deformity

swelling

oedema

haematoma and ecchymosis

abrasions and lacerations

teeth trauma

paraesthesia of the inferior alveolar nerve

what will clinical examination of mandibular fractures reveal?

extraoral palpation with thumbs on both side of the mandible

- feel the inferior margin of the mandible, body, angle, symphyseal area and alveolar processes

- when we feel a visibly raised point (step deformity) this is a red flag and indicator of mandibular fracture

what is bimanual palpation used to diagnose and how does it work?

- thumbs on occlusal surfaces of both sides with rest of hand supporting mandible

- start in retromolar region

- begin gently

- gradually increase force being careful not to dislocate fragment further

how is a condylar fracture palpated?

- thumb placed anteriorly to tragus

- 5th finger inside external auditory meatus

- patient moves jaw side-side & up-down

- lack of movement on one side = fracture

- condyle not found in normal position (anterior to tragus) = fracture

how is an alveolar fracture palpated?

- thumb + index hold the alveolar ridge

- bucco-lingual pressure applied at cervical lvl of teeth

- movement = fracture

how is a ramus fracture palpated?

- one hand palates ramus

- other hand holds chin and applies upward and downward force

what is the differential diagnosis for mandibular fractures?

TMJ luxation should be differentiated from a condylar fracture