Present by: Bushara PING Dental student in year 6th ( Faculty of Odontostomatology Phnom Penh)

1. Mandibular Fracture ( part I ) Bushara PING, student in year 6th,, faculty of dentistry Phnom Penh

2. Classification by type of fracture Simple FX Green stick Fx Commuted Class1 Class2 Class3 in a edentilous

3. Mandibular Force

5. Fracture pathologic: infection, tumor, osseoradionecrosis.

6. bone disease: ossteoporosis, osteomalacia*,Rickets*,intoxication ( with mercure, phosphore..)osteomalacia*: soften of the bone typically through a deficiency of Vitamin D or Calcium. Rickets* ( rachitis) : Vit D deficiency in childrend.

8. Occlusion Examination Posterior contact & anterior open bite > bilateral Condylar or angle Fx Posterior open bite is common with the FxParasyphysia Unilateral open bite > Fxparasymphysia or angle Fx ( one side) Retrognathic Occlusion > Fx angle or condylar Open bite on opposite site and deviation of the chin to the Fx side > Fxcondylar neck

9. Mandibular Force

11. Mal occlusion

12. Fx partial parasymphysia with Fxalveolo-dentairkhmer soviet hospital

13. How to fix the fracture? Maxilomandibular Fixation ( MMF): fix for 30 to 40 day. But can’t used with the open fracture. ( using ache base and wire) (Open reduction) Non-rigid fixation:using wire punch the bone and fix. (Open reduction) Rigid fixation: using Plate. External pin fixation: Lag scrow, DCP

14. MMF

15. MMF

16. MMF

17. Ivy Loop faxation

18. Non-Rigid fixation

19. Non rigid fixation ( wire opacity in radiography)

20. Intubation technic

21. Rigid fixation ( ORIF) ORIF*= Open Reduction and Internal Fixation

22. Titanium plate using in rigid fixation

23. External Pin Fixation

24. Lag screw, DCP

25. General principle for treatment Tetanus Nutrition Almost Fx can be open fracture > Reduction and Fixation Postoperative monitor Oral care H2O2, irrigation, soft tootbrush Two weekly chack.

26. Reference Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000) Maladies des parties molles de la cavitébuccale, Dr Keam Born Master Dentistry Vol 1: oral and maxillofacial surgery, Radiology, Pathology and Oral Medicine ( Paul Coulthard, Keith Horner, Philip Lloan, ElizabthTheaker) Oral Surgery: Fragiskos D. Fragiskos ( Springer-Verlag Berlin Heidelberg 2007)

27. Next Session? Complication post-operation. Tooth luxation. Fxmandibular in Children, how to menage the eruption of Permanent tooth. Fixation in edentulous patient

28. Thank you for you attention

29. Facture Mandibular part II Injury to the tooth Extraction if the root fracture. Classification of tooth luxation: Concussion: without displacement > periodontium trauma Subluxation: displacement> periodontium trauma Luxation: could be extrusive, intrusive or lateral direction displacement. Avulsion: completely displacement. Best chance of saving tooth is re-implanted in under 1 hrs since avulsion ( master dentistry table 8 page 124) Example of dental injuries

31. Reference: Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000)

34. Splint fabrication To make the splints, an impression is first made. Next, a cast made out of plaster or stone is made from the impression. Then acrylic splints are made with holes for wiring and grooves for circumandibularand circumzygomatic fixation.

35. Splint fibracation

36. Diagram illustration

37. Ooy!!!!!! Ooy!!!!

38. Fixing with Denture prepatation Edentulous patients may undergo closed reduction by wiring the patient's dentures to his jaws using circumandibular and circumzygomatic wires.

39. Complication Socioeconomic condition greatly affects outcome • Infection - In a prospective study by James of 422 fx -infection rate was 7% of which 50 % were associate with fx or carious teeth, of the 177 fx requiring ORIF, 12 % became infected

40. Complication Delayed healing(3%) and nonunion(1%) – most common cause in infection – second most common cause is noncompliance – inadequate reduction, metabolic or nutritional deficiency can play a role Nerve paresthesia’s (Inf. Alveolar nerve) occur in 2% Malocclusion TMJ problems

41. Unilateral open bite

43. First Aid Adult Childrend

44. Reference Karen Stierman, M.D Byron J. Bailey, M.D., FACS ( year 2000) Maladies des parties molles de la cavitébuccale, Dr Keam Born Master Dentistry Vol 1: oral and maxillofacial surgery, Radiology, Pathology and Oral Medicine ( Paul Coulthard, Keith Horner, Philip Lloan, ElizabthTheaker) Oral Surgery: Fragiskos D. Fragiskos ( Springer-Verlag Berlin Heidelberg 2007) Education Program: Trauma life support Training Phnom Penh 8-13/10/2010 Bernard M. Jaffe, M.D Professor of surgery Tulane University

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46. Thank you for attention