Mandible Fractures

Mandible fractures are often caused by blunt or penetrating trauma and are one of the most common facial fractures. It is critical to understand facial and mandibular anatomy to best evaluate, classify, and treat mandible fractures. The primary goal of treatment is to restore the jaw to the preinjury occlusion. This can be achieved through open reduction with internal fixation or closed reduction with maxillomandibular fixation (MMF) in conjunction with dietary changes and/or physiotherapy. The main risks and concerns in mandible fracture management are infection, malunion, airway compromise, pain, and temporomandibular joint (TMJ) dysfunction. This chapter will provide a brief overview of facial and mandibular anatomy as well as common treatment methods and surgical interventions. This review contains 17 figures, 2 tables, and 43 references Key words: Mandibular fracture, maxillomandibular fixation, occlusion, malunion, closed reduction, open reduction, TMJ dysfunction

Sagittal Maxillary Fracture: Diagnosis and Management

Background The sagittal maxillary fracture often coexists with maxillary fractures and warrants a definitive management strategy together with other maxillary fractures. Method This study was conducted on 60 patients suffering from sagittal maxillary fracture. Palatal fractures were classified into six subgroups. During management, patients were divided into three groups. In group A, patients with type I, IV, V, and VI were managed with maxillomandibular fixation and anterior maxillary buttress stabilization. Group B patients included type II, III, and IV palatal fractures. These fractures were undisplaced and were managed with maxillomandibular fixation, anterior alveolar plating, and anterior maxillary buttress stabilization. Group C included type II and III fractures with visible gap in the palate and were managed with maxillomandibular fixation, palatal vault plating, anterior alveolar plating, and anterior maxillary buttress stabilization. Result Sagittal maxillary fracture was more common in young males. Le Fort I and II fractures were more frequently associated with it in isolation or in combination. Parasagittal and sagittal fractures were the most common types. Sixteen patients of group A, twenty patients of group B, and twenty-four patients of group C were managed. Malocclusion (2), plate extrusion (2), and oroantral fistula (2) were the most common complications. Conclusion Sagittal maxillary fracture can be diagnosed with clinical and radiological examination. Palatal vault plating is required in displaced palatal fractures of type II and III. Single plate fixed in posterior half of middle one-third of palate gives sufficient stability to the palatal vault.

Counter-Clockwise Rotation of Maxillomandibular Complex and Customized Joint Reconstruction as a Single Stage Management for Facial Deformity in Temporomandibular Joint Ankylosis: A 2 Year Follow-Up

Study Design: A case report with 2 year follow up. Objective: The aim of this paper is to present a case of bilateral TMJ ankylosis with coexisting dentofacial deformity and occlusal cant, and 2 years follow-up evaluation for changes and relapse in the facial skeletal and airway. Methods: The patient was planned preoperatively by computer simulation for bilateral interposition arthroplasty and surgical jigs, coronoidectomy, detachment of masseter and medial pterygoid muscles from ramus, LeFort 1 osteotomy, temporary maxillomandibular fixation, counter-clockwise rotation of the maxillomandibular complex, maxillary fixation and iliac crest graft, reconstruction of bilateral TMJ with custom-made total joint prosthesis, dermal fat interposition in the joint, reattachment of muscles, maxillomandibular fixation, and active physiotherapy. Results: Average ramal length improved by 28.35 mm (81%) in the immediate postoperative and 25.6 mm (73.45%) at 2 years, showing 2.75 mm (4.4%) vertical bone resorption at the angle region. Point A advanced by 1.3 mm, but showed 4.5% horizontal relapse; Point B advanced by 10.2 mm, but showed 9.5% relapse at 2 years. Pogonion advanced by 26.3 mm (70%) but presented 7 mm (10.9%) horizontal relapse; and menton by 28.6 mm (89%) with 5.4 mm (8.9%) relapse at 2 years. The mean mandibular plane angle decreased by 33.5° (42%) after surgery and by 32° (40%) at 2 years. Pharyngeal airway increased by 49% after surgery and by 75.6% at 2 years follow-up. Conclusion: This computer simulated approach for the management of bilateral TMJ ankylosis with facial deformity and occlusal cant improves aesthetics, function and airway in a single surgery, thereby reducing the management cost and time, and deliver precise results.

3-Dimensional Plates Versus Conventional Mini plates in Maxillofacial Trauma- A Review

Maxillofacial trauma is any physical injury to the facial bones. Facial bones are frequently fractured bones in RTA, Assault, Domestic violence etc. Facial trauma includes Maxillary fractures, Mandibular fractures, Orbital Fractures, Nasal Bone Fractures, soft tissue injury such as lacerations, bruises etc. Over the years, there are many refinements in the management of maxillofacial trauma. The incidence of maxillofacial trauma is more in males because they are involved in more physical activities and assault compared to women. In Older times for facial bone fractures, surgeons performed maxillomandibular fixation using wire osteosynthesis for minimum three weeks to 6 weeks, and mouth opening was difficult, poor oral hygiene leading to periodontal problems, difficulty in speech and masticatory functions. The management of maxillofacial trauma includes the use of Maxillomandibular fixation using wire osteosynthesis, conventional mini plates and 3-D plates. For the management of facial bone fractures, Maxillofacial surgeons perform open reduction and internal fixation(ORIF) whenever needed. In the case of ORIF, Surgeons use mini plates either 3D or Conventional Plates for stabilising the fractured segments. This technique requires skill and experience and is also expensive. The advantages of this method are improved quality of life. The objective of this review is to compare 3-Dimensional plates and Conventional Plates in Maxillofacial trauma.