mandibular body, symph. and para-symph. fracture

1. Oral & Maxillofacial prof.
Cairo University.
Atef Fouda

4. Body fracture :
Fracture line in the area distal to
the canine to the anti-gonial
notch.
Body Para-symph.
Ramus Angle
Body
Dento-alveolar
Dento-alveolar

5. Body fracture :
Signs and symptoms:
-Pain – Tenderness- Swelling.
-Hematoma.
-Malocclusion.
-Numbness.
Diagnosis:

6. Diagnostic aids Panoramic x-ray
Body fracture :

7. Diagnostic aids
Body fracture :
Lateral oblique
view

8. Diagnostic aids
CT scan-Cone beam.
Body fracture :
-In case of comminuted fracture.
-For detection of teeth condition.
-For detection of nerve injury.
-In case of treatment with lag screw.

9. 1-Closed reduction with maxillo-mandibular fixation
(MMF).
Body fracture:
Treatment protocol:

10. 2- Inter-osseous wiring with MMF.
Treatment protocol:
Body fracture:

11. 3-Open reduction with mini-plates.[intra-oral approach].
Treatment protocol:
Body fracture:

12. 3-Open reduction with mini-plates.[Extra-oral approach].
Body fracture:
Treatment protocol:

13. 4-Reconstruction plate[Comminuted
body fracture].[Extra-oral approach].
Treatment protocol:
Body fracture:

15. Symphyseal and parasymphyseal fracture :
Signs and symptoms:
-Pain – Tenderness- Swelling.
-Chin /mucosa /sublingual wound or hematoma.
-Inability to control salivary secretion.
-Mandibular deviation or open bite.
-Malocclusion.
-Possible concomitant condylar trauma..
-Numbness.
-If bilateral air way endangering due to tongue
displacement
Diagnosis:

16. Diagnostic aids
Panoramic x-ray
Symphyseal and parasymphyseal fracture :

17. Diagnostic aids
Occlusal view
Symphyseal and parasymphyseal fracture :
Minimal displacement
Severe Lingual
displacement
Moderate Lingual
displacement
Symphyseal parasymphyseal
parasymphyseal

18. -MRI
-CT imaging.
-Patients that will be treated with closed reduction.
Diagnostic aids
Symphyseal and parasymphyseal fracture :

19. Symphyseal and parasymphyseal fracture :
Risk of bilateral fracture

20. 1-Closed reduction with maxillo-mandibular fixation (MMF).
symphyseal fracture:
Separated arch bar.

21. symphyseal fracture:
1-Closed reduction with maxillo-mandibular
fixation (MMF).[6 weeks ]
-Non or minimally displaced fractured segments.
-Free TMJ MRI findings.
-Economic reasons.
Minimal displacement

22. symphyseal fracture:
2-Closed reduction with maxillo-mandibular
fixation (MMF).[4 weeks ]
-TMJ MRI findings.
-Monofixation with mandibular arch bar [2 weeks].

23. 3- Inter-osseous wiring plus MMF.[6weeks]
Parasymphyseal fracture:
Moderate Lingual
displacement
-Used for lingual displaced segments.
-Delayed fracture.
-No TMJ findings.

24. 4- Inter-osseous wiring with MMF.[4weeks]
-Used for lingual displaced segments.
-Delayed fracture treatment.
-TMJ findings.
-Monofixation with mandibular arch bar [for two weeks].
Parasymphyseal fracture:

25. symphyseal fracture:
-Required accessibility for screws Insertion.
Parasymphyseal fracture:
5-Open reduction with two lag screws
fixation.+Tension band or lingual supporting splint

26. symphyseal fracture:
-Tension band or lingual supporting splint should Share with screws. [Champy/AO-
ASIF]
Parasymphyseal fracture:

27. Or
lingual supporting splint
Tension band
1-Arch bar as mono fixation.
2-Bridle wire/ Essig wiring.
symphyseal fracture:
Parasymphyseal fracture:

28. 6-Open reduction with two mini-plates.
symphyseal fracture:
-According to Champy principles
two mini-plates required for
stability.
Parasymphyseal fracture:

29. 8-Inferior border placement of the mini-plate.
-Insertion of two perpendicular
mini-plates for fracture therapy of
the mandible is an efficient
procedure without tension band or
lingual splint.
-low profile of the plates and
inferior border placement of the
mini-plates prevents their removal
for prosthodontic purposes.
Parasymphyseal fracture:

30. 8-Inferior border placement of the mini-plate.
Parasymphyseal fracture:
Disadvantages:
-Plate form requires complete
set of different curvatures.
-Tension band doesn’t follow
fixation principles.
-Require extra-oral opening.

31. 9-Open reduction with 3 D lock plate.
symphyseal fracture:
-According to Champy principles One
3D plate is enough for proper stability.
-Torsion prohibited .
-Locked plates are
considered the best line of
treatment for symphyseal
fracture.
Parasymphyseal fracture:

32. 10-Combination treatment.
-Second common best line of treatment.
-Direction of the fracture line may restrict lag screw
fixation procedures.
symphyseal fracture:
Parasymphyseal fracture:

33. 11-Comminuted fracture.
-Construction plate and multiple micro plates [1.2]
with short monocortical screws [2-4mm long]
-Lingual splint used for proper stability[tension band].
Parasymphyseal fracture:

34. Intra-Oral approach is the most common.
1-Full gingival pyramidal flap.
2-Flap procedure without gingival involvement.
3-Sulcular incision.
Extra-Oral approach:
Submental incision.
Parasymphyseal fracture: symphyseal fracture:
Surgical approach:
2