impingement of coronoid process on zygomatic arch causes what?
trismus
an elongated face would be from bilateral ___, ___ and ___ fractures
subcondylar, angle or body
bilateral parasymposis fractures could cause what appearance in a clinical exam?
retruded chin
An anterior openbite would result from bilateral ___ or ___ fractures, while posterior openbite would be from anterior alveolar process or parasymphosis fractures
condyle or angle fractures
An ipsilateral angle and parasymposis fracture cause what clinical condition
openbite on one side
Midline symphsis and condylar fractures could case a ___ ____
posterior crossbite
It is advisable to have views of the mandible in at least __ planes oriented (45, 90) degrees to each other
2, 90
The pan film is most favored. name two reasons why, and 2 disadvantages, one of which is difficulty in gauging (B/L or M/D) displacement, and lack of fine detail in which to areas of the mandible?
simple technique and most detail
but
pt needs upright, difficult to det B/L disp, lacks fine detail in CONDYLE and SYMPHYSIS regions
name to injuries that could also occur during jaw fracture to look for
cervical spine
pneumothorax
ruptured spleen
what is the PRIMARY goal of tx of mandible fracture
re-establish occlusion
name 4 reasons you would extract a tooth when fixing a fractured mandible.
sig mobility
root exposed, markedly distracted
tooth interferes w/ reduction or fixation of fracture
gross dental pathology
When fixing a jaw fracture it is routine to remove the 3rd molars. Name the 2 situation when you should NOT remove them.
they are erupted into occlusion, good condition, not mobile
they are fully impacted in bone, non mobile, without root fracture and it is part of maintaing the ruduction of the fracture
most mandibular fractures are repaired by: a) IMF b) closed reduction (wire shut)
a) closed reduction
IMF varies with clin situation and pt age and health - 6 weeks heal time for IMF
decide which is advatage of closed reduction and which is adv of open reduction
1 quick, cheap, simple
2 done on outpatient basis, less tissue morbidity, no foreign material put into body
3 normal nutrition, less airway probs
4 primary bone healing
5callus formation (bridging of bony gaps)
6bone fragments re position via direct vision
7 early return to function
closed red: 1, 2, 5
open red 3, 4, 7
name 3 disadvantages of open reduction
increased oper time
prolonged anest
expensive hardware
more parasthesia risk
more skill needed
scarring
unforgiving procedure
state whether it is an indication for open or close reduction
1displaced unfav fract thru angle, body or parasymphosis :
2non displaced favorable fract
3grossly comminuted
4multiple facial bone fractures
5midface fract, and displaced bilat condlyar fract
6mand fractures in children w developing dentition
7coronoid fracture
8fract of edentulous mand w severe displacement
9edentulous maxilla oppose mand fracture
10delayed tx w/ interposing soft tissue
11condylar fracture
12asthma, COPD, claustriphobic pt
13 edentulous mandible fractures
OPEN 1, 4, 5, 8, 9,10, 12
CLOSED 2, 3, 6, 7, 11, 13
what is the most common technique for closed reduction
Direct ID wiring
Indirect ID wiring (Ivy loops)
Arch bars (Erich)
Gunning splints/llingual splints
External pin fixation
Arch bars most common
which CR technique(s) is simple but requires a suitable number shape and quality of teeth present on each jaw fragment?
Ivy loop, Arch bars
State for each if it is an advantage of Intraoral or extraoral open reduction
1 negligible scar
2 allows visualization of buccal lingual and inferior cortices
3 min risk of facial nerve injury
4 relatively quick and simple dissection
5 easy to manipulate segments
6 can use pre existing lacerations if present
Intraoral OpenReduction: 1, 3, 4
Extraoral: 2, 5, 6
name 3 disadvantages of intraoral open reduction
name 3 disadvantages of extraoral open reduction
Intraoral:
limited visibility
cumbersome fragment manipulation
increased risk of facial nerve injury
Extraoral:
scar formation
(thats all that was listed)
what are the 4 classification of condylar fractures?
Extra interesting surgery class
extracapsular
intracapsular
subcondlylar
condylar head
the most commonly used managments of condylar fractures are ____ (closed, open ) reduction or ___ ____.
closed reduction or non surgical
Condylar fractures:
closed reduction or non surg is most common, but what would be the 4 indications of open reduction?
fracture into Middle cranial fossa
Inability to open mouth after 1 week due to mech. obstruction
Lateral extracapsular displacement of condyle
Foreign body in the joint capsule
no IMF, early mobilization with active jaw movement and pysical therapy are parts of n____ s_____ management of condylar fractures
non surgical
for closed reduction of condylar fractures early mobilization and physical therapy are indicated, T or F
True
Night elastics are part of which management of condylar fractures
Nonsurgical
Closed reduction
Open reduction
Closed reduction
T or F IMF is used for closed reduction of condylar fracture
True, for 3 weeks
Place in order of most common to least common type of condylar fracture location
condylar process
coronoid process
ramus
angle
body
alveolar process
symphosis
