Treatment Planning & Seminars Case Presentation

Ahmed Amer Zebari Zuhair Al Zain

200910256 200911234

* 79 Years old man, full denture user with long standing controlled hypertension sustained a fall on floor in toilet. He was presented with pain while talking & inability to open mouth wide.

Differential Diagnosis:
* Body 43% * Condylar 38 % * Angle 15% * Symphysis & Parasymphysis 4% * Alveolar * Coronoid * Ramus

DIAGNOSIS OF FRACTURED MANDIBLES

* History (Past Medical History, Type and Direction of Traumatic Force) * Clinical Examination (extraoral &intraoral ecchymosis, Swelling, pain and tenderness to palpation, etc) * Radiographic Examination (OPG), mandible series radiograph and CT scans can be used to diagnose and plan the treatment

Clinical Assessment:
1- Inspection. 2- palpation. 3- Intra-Orally.

Diagnostic Imaging:
The facial radiographic examination should depend to some degree on the clinical examination and the suspected injury. suspected The purpose of radiographs is to confirm the clinical diagnosis & determine the extent of the injury.

Radiographic evaluation of the mandible requires two or more of the following radiographic views : - Panoramic view. - Posterior Anterior View. - Lateral Oblique view. - CT scan. - Towne's view.

- PA view : Body Fracture

- LO view: Angle Area Fracture

- Towns View: Dis. Of Cond. Fracture.

- Panoramic View: Dis. Fracture of body & Subcondylar fracture

Treatment Of Condyle:
- Some patients can be treated with a liquid to soft diet and careful follow-up evaluation. - If malocclusion is present after periarticular edema resolves, closed reduction is performed.

- Non-operative management of condylar fractures can be used more liberally for edentulous patients, who can tolerate moderate degrees of condylar displacement. New dentures can compensate for the change in jaw relations.

Treatment Options Of Condylar Fractures:

1- No Treatment.
2- Closed Reduction.

3- Open Reduction.
4- Endoscopically Assisted.

Treatment Options Of Condylar Fractures:

1 - No Treatment: No treatment is considered when no occlusal discrepancy or Functional impairment exists. 2- Closed Reduction:

- Very high condylar neck fractures without dislocation. - Intra-capsular Fractures. - Elderly Patient.

- Endoscopically Assisted:

_ It reduces the risk to the facial nerve and minimize scaring.

_ Using intraoral approach, a Ramus incision is made and the masseter muscle stripped to create the optical cavity.

_ Under vision and with special instruments the fracture is manipulated and reduced.

Fractures of Edentulous Mandible:

- Resorption. - Aging process & bone structure. - Cross-Sectional area. - Type of Fracture.
- Trismus is a relatively constant finding with mandibular fractures.

Atrophic edentulous Mandible mostly fracture at the midbody, where the atrophy is most advanced.

Control Of Pain: - If present : Give adequate analgesia. ( Avoid giving powerful analgesics, which depress the level of consciousness & respiration.
-

Treatment for edentulous mandibular fracture:

Methods of immobolization :
1- Indirect Skeletal Fixation: Gunning-type splint. 2- Direct Skeletal Fixation : A- Extra Oral Pin Fixation B- Transosseos wiring. C- Bone plating.