try to make it simple

1. WIRING OF
MANDIBLE
GROUP 2 (SECTION C)
PRESENTED TO: DR. ASAD MANZOOR , DR. MISBAH

2. OUTLINE:
 Introduction
 Anatomy
 Etiology
 Signs and symptoms
 Diagnosis
 Treatment
 Repair of fracture

3. INTRODUCTION
 Fracture of the mandible are very common due to its prominence and location.
 Mandibular fracture also known as fracture of jaw, are breaks through the
mandibular bone .
 Although any breeds and species can be affected .
 The pattern and type of fracture is determined by the
a) Direction of force
b) Mechanism of injury.

4. Three most common mandibular fractures are:
1) Mandibular symphysis
2) Mandibular body
3) Mandibular ramus
SITES FOR MANDIBULAR FRACTURE

5. Lateral view

6. MEDIAL VIEW

7. MUSCLES

8. BLOOD SUPPLY
 Mental. A
 Facial .A
 Transverse facial .A
 Lingual .A
 External carotid .A
 Cranial laryngeal .A

11. ORTHODONTIC SURGICAL
INSTRUMENTS
1. Scalpels:
Used for incision
(i) Small general purpose blade
(ii) Blade for opening abscesses
(iii) Blade for fine dissection
2. Diagonal Wire
Cutter
3. Wire Bending
Used for bending wire

12. ORTHODONTIC SURGICAL INSTRUMENTS
4. Light Wire Bird Beak
Used for forming precise loops
5. BABCOCK Suture Wire, Stainless Steel
B&S Gauge Diameter
18 GA .040”
20 GA .032”
22 GA .025”
24 GA .020”
25 GA .018”
26 GA .016”
28 GA .012”
30 GA .010”
32 GA .008”
34 GA .006”
36 GA .004”
18- to 20-gauge (for dogs)
20- to 22-gauge (for cats) orthopedic wire

13. 6. Lip retractor
7. Drill machine

14. 8.Wire passer
9. Mouth gags

15. SIGNS AND SYMPTOMS
Pain
 Drooling of saliva
 Inability in eating
 Malocclusion of teeth
 Bleeding
 Difficulty in opening of jaw
 Swelling of the face
Fractured teeth

16. CAUSES OF MANDIBLE
FRACTURE
 Physical factors
▪Trauma
▪ Road accident
▪Gunshot wound to the face
 Pathological factors
 Neoplasia
 Metabolic bone disease
 Infection

17. DIAGNOSIS
 History of physical Trauma or Injury.
 Physical Examination and Clinical Signs
 X-ray of Mandible
 Radiographs from lateral, ventrodorsal, oblique and open mouth view for full extent
examination of the fractured part of the mandible.

18. Treatment of Mandible Fractures
• Primary Goal:
1. Restoration of proper dental occlusion.
• Basic Principles:
1. Stable anatomic or functional fixation of fracture fragments
2. Avoidance of soft tissue entrapment and dental trauma
3. Assessment of tissue viability

19. Different Scenarios of Mandibular
Fracture

20. Firstly, airway regulation to help the patient for successful
respiration.
Rapid acting intravenous induction is necessary.
Oral intubation is necessary for initial approach .
endotracheal intubation will help to prevent the suffocation
during surgery.
INITIAL APPROACH

21. 1) The oral cavity is rinsed with dilute antiseptic solution such as 1percent
povidone -iodine.
2) If an open fracture is present, antibiotics are used before surgery to avoid
the risk of infection.
3) Ampicillin with sulbactam (10-20mg kg)or third generation cephalosporin
are effective.
PREOPERATIVE CARE

22. Treatment of mandibular
symphysis
Type of fracture Treatment options
separation • Cerclage wire
• Hemicerclage wire
• screw

23. 1) TREATMENT OF MANDIBULAR
SYMPHYSIS FRACTURES VIA
CERCLAGE WIRE:
 Separation of Mandibular Symphysis is very common in dogs.
 Following the manipulative reduction of the symphysis, a single 6 inch to 8 inch
long, 18- to 22-gauge stainless steel wire is threaded through a prebent needle and
then introduced caudal to canine tooth lateral to the horizontal ramus through the
mucosa and out through the skin on the midline ventral to the mandible.
 The other end of the wire is introduced in a similar manner and the orthopedic wire
is directed ventral chin incision ,twisted as they exit the skin.
 Reduction of the fracture is obtained while the wire is tightened. The wire is cut off,
leaving approximately three twists. It is usually allowed to remain in place for 12
weeks. Removal can be accomplished with a wire cutter by snipping the wire
between the canine teeth and pulling it out ventrally.

24. Mandibular Symphysis
Fractures

26. HEMICERCLAGE WIRE
 Technique prevents shearing.
 Can be used for revision surgeries.
 Ventral approach to mandibular symphysis is performed and fracture is reduced ,
hole is drilled just caudal to the roots of canine teeth , perpendicular to the
symphysis.
 A hemicerclage wire is inserted through the hole and is tightened ventrally.

27. 2) FRACTURES OF THE BODY
OF THE MANDIBLE

28. INTERDENTAL WIRING
 Holes are predrilled in the alveolar border of the mandible between the teeth with a
small krischner wire. A piece of 0.4 to 0.5mm orthopedic wire is inserted into these
holes in loops. The wire is passed through the loops intraorally.
 The loops are tightened individually over the intraoral wire. Alternatively , a 0.6 mm
Krischner wire can be used as an intraoral splint , around which the wire loops are
anchored. The oral part of the splint can be reinforced with dental composite if
deemed necessary.

31. 3) FRACTURES OF
MANDIBULAR RAMUS

32. INTERFRAGMENTARY WIRING
 An orthopedic wire is inserted on the oral side of the mandible through two
predrilled holes , around 5mm away from fracture line .
 The location of the drill holes is also dictated by the location of the tooth roots,
which should be avoided. An additional wire can be placed at the aboral side of the
mandible to enhance neutralization of shear and rotational forces.
 In case of butterfly fracture , the directly from the oral cavity , provided the fracture
stability is judged to be sufficient for only one suture to be placed at the rostral
mandibular angle.

34. INTERARCUATE WIRING
 Valid alternative to primary fracture repair, especially in multifragmentary fractures.
 0.6 or 0.8mm wire is inserted through predrilled holes in the oral border of maxilla
mandible, and is tightened just enough for the cat/dog to open the mouth a few
millimeters.
 The holes are usually drilled between the premolar and molar tooth roots.
 It is mostly done bilaterally but sometimes applied sometimes for correction of
lateral deviation of lower jaw.
 Release the fixation immediately in case of vomiting.

38. COMPLICATIONS
Lower jaw heals in wrong alignment.
The patient may suffer from a malocclusion .
 May injure the tooth roots and neurovascular bundle within the mandible.
Incisional dehiscence.
Infections.
Mandibular drift and instability.

39. POST OPERATIVE CARE
 Analgesics for at least 48-72 hours after surgery.
 Post operative antibiotics are also recommended for first 5-7 days.
 Moist food to protect surgical incisions.
 Access to chew toys or bones should be restricted until incision is healed.

40. Repair of a Fracture

41. STAGES IN THE HEALING OF A
BONE FRACTURE
 Hematoma formation
 Torn blood vessels hemorrhage
 A mass of clotted blood (hematoma)
 forms at the fracture site
 Site becomes swollen, painful,
 and inflamed
 3-4 hours
Hematoma

42. FIBROCARTI LAGINOUS
CALLUS FORMS
Granulation tissue
(soft callus) forms a few
days after the fracture
Capillaries grow into the
tissue and phagocytic
cells begin cleaning
debris
2 Fibrocartilaginous callus
formation
Internal callus
(fibrous tissue and
cartilage)
External callus
New blood
vessels
Spongy
bone
trabeculae

43. Bony callus formation
 New bone trabecular appear in the fibro
cartilaginous callus
 Fibro cartilaginous callus converts into a bony
(hard) callus
 Bone callus begins 3-4 weeks after injury, and
continues until firm union is formed 2-3 months
later
3 Bony callus formation
Bony callus of
spongy bone

44. CONT.
The fibro cartilaginous callus forms when:
Osteoblasts and fibroblasts migrate to the fracture and begin reconstructing the
bone
Fibroblasts secrete collagen fibers that connect broken bone ends
Osteoblasts begin forming spongy bone
Osteoblasts furthest from capillaries secrete an externally bulging cartilaginous
matrix that later calcifies

45. Bone remodeling
 Excess material on the bone shaft
exterior and in the medullary canal is
removed
 Compact bone is laid down to
reconstruct shaft walls
4 Bone remodeling
Healing
fracture