38. MANDIBULAR FRACTURES. SURGICAL AND ORTHO-SURGICAL TREATMENT

what are the ortho-surgical method indications?

when closed reduction is possible but there aren't enough stable teeth for fixation

what type of wiring do we do? explain it

circummandibular wiring

- wire is passed around the body of the mandible with a large needle

- 1 end of the wire is introduced lingually and passes bucally

- wire is tightened around the plate of the patients denture

what are the indications for surgical methods of treatment?

- edentulous jaws

- edentulous fragment of fracture

- unstable teeth

(absence of/no stable teeth to support IMF)

-oblique fractures with gross dislocation (unfavourable fracture)

-open fractures (communication with oral cavity/skin)

-fractures in regions of cysts

-patients with mental disorders (cant cooperate for IMF)

contraindications of surgical tx

- acute infection

- massive blood loss

- shock

what are the principles for treatment?

- accurate reduction of fragments

- dense and firm contact of fragments (ensure no gaps)

- firm fixation to reduce pathological mobility

- gradual introduction of function

what are the closed osteosynthesis methods?

1. with Kirschner wire

2. with circummandibular wire (circlage wiring)

what are the indications for closed osteosynthesis with Kirschner wire?

fractures of the mentum, condylar process and angle of mandible

what are the disadvantages of closed osteosynthesis with Kirschner wire?

- rotation around the wire can cause altered centric position and slower healing

- the wire is left outside of the tissues so there is a higher chance of infection

what are the indications for the closed osteosynthesis with circummandibular wire?

edentulous and paediatric patents, oblique fractures with minimal dislocation

what is the technique for the open osteosynthesis with suture wire?

- make a skin incision

- expose the bone fragments

- reduce bone fragments

- drill 0.8-1cm holes from the fracture lines

- steel wire is placed through the opening

- X, Z or N shaped sutures are tied firmly

what is the technique for open oseosynthesis by metal plates?

- titanium compression plates are used as they are good for healing

- each plate has 2/4/6 openings

- screws anchor them to fractures

what is the technique for open osteosynthesis with miniplates?

- intraoral incision (no visible scar)

- fragments are surgically reduced

- centric position is achieved

- miniplates are attached to bone fragments with screws

- remove the plates after 4-6m