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ORAL SURGERYIPAIN CONTROL LEGEND Major Topic Abbreviation Adrenal cortex Adren Cort Anatomy Anat Anesthesia Anesth Biopsy Biopsy Disorders/Conditions Disord/Cond Drugs Drugs Exodontia Exo Fractures Fractures General Information Gen Info Implants/Grafts Impl/Grfts Miscellaneous Misc. TMJ TMJ Copyright(!;)2001- DENTALDECKS Fractures ORAL SURGERY/PAIN CONTROL The treatment of a mandibular fracture using only intermaxillary fixation (IMF) is called: • Openreduction • Closedreduction Copyright©2001- DENTALDECKS • Closed reduction " 'ItiscalledclosedreductionbecauseitdoesnotInvolvedirectopening,exposure,andmanip ulationofthefractured area. Formsof immobilizationofafracture: 1. Abarton bandage is the simplest form of immobilization. Primarily a first aid measure untildefinitivetherapycanbeinstituted. 2. Intermaxillary fixation (IMF) is establishing a proper occlusal relationship by wiring the teeth together.This method will successfully treat mostfractures of the mandible.The main methodsforsuch fixation are wiring,arch bars,and splints.This isthe classical way to Immobilizethe fractureafterclosed reduction. 3. External skeletal fixation is used in most cases in which the management of a fractured bonesegmentisnotsatisfactorilyaccomplishedby intermaxillaryfixation.Itinvolvesthe placement of screws or pins through the skin on each side of the fracture and a cold cure acrylicbarwhichholdsthescrewsinproper relationshipwiththefractureinthereducedposi tion.Itiscumbersomeandestheticallydispleasing. 4. Direct intraosseous wiring combinedwithaperiodofIMF isthetraditional methodofbone stabilizationafteropen reduction.Thismethodofstabilizationcan beaccomplishedthrough avarietyofdifferentwiringtechniques.Thewireisplaced throughholesoneitherside ofthe fractureandimmobilizationisaccomplished bytighteningthe wires. Fractures ORAL SURGERYIPAIN CONTROL Zygomatic arch fractures can be nicely demonstrated by which radiographic view? • Water's view • Lateralskull view • Posteroanterior skull view • Submental vertex view Copyright©2001- DENTAL DECKS • Subment&yerfex view Thistypeoffracture maynotcauseanyproblemotherthan perhaps aslight sinkingof thecheekbonearea.There maybe someencroachment and impairment inclosure of thejaw ifit comesdownand entrapsthe coronoidprocess ofthe mandible. Possible complications include: • Paresthesia (mostcommon) - usuallysubsides • Theantrum (sinus)may befilled with ahematoma, whichusuallyevacuatesitself • Ocularmusclebalancemay beimpairedbecauseoffractureoftheorbitalprocess Important: Fractures of the facial bones, particularly the zygomatic complex may on rareoccasionsbe complicated by damage to the contents of the superior orbital fissure. Note: Fractureofthe infraorbital rim presents withthefollowing symptoms: • Numbnessofthe followingareason theaffected side: upper lip,cheek,andnose. Remember: TheWater's view isbestto evaluateorbital rimareas. .... Fractures ORAL SURGERYIPAIN CONTROL Which of the following is the most common pathognomonic sign of a mandibular fracture? • Nasalbleeding • Exophthalmos • Malocclusion • Numbnessintheinfraorbitalnervedistribution Copyright©2001- DENTALDECKS • Malocclusion Othersignsand symptons ofa mandibularbodyoranglefracture include: • Lowerlipnumbness • Mobility,pain,or bleedingatthefracture site Anatomic distribution of mandibularfractures: • Angle (30%)mostcommon site • Condylar neck (25%) • Symphysisarea (22%) • Body (17%) • Ramus (2%) • Coronoidprocess (1%) leastcommon site Notes: 1. Indicationsforopenreduction includecontinuedgross displacementofthebony segments andanunfavorablefracture that islikelyto result infurtherdisplacementofthe fractured seg ments caused by muscle pull,This type of reduction is commonly performed for displaced angleor bodyfractures. Remember: Condylarneckfracturesare usuallytreated byclosed reduction. 2. Inafractureinvolvingtheangleof anedentulousmandible,theproximalsegmentisusu allydisplaced anteriorlyand superiorly. Fractures ORAL SURGERYIPAIN CONTROL Inpatientswhohavea LeFort IIfracture, acommon finding isparesthesia overthe distribution of the: • Infraorbitalnerve • Inferior alveolarnerve • Mylohyoid nerve • Hypoglossalnerve Copyright©2001- DENTAL DECKS • Infraorbital nerve Midfacialfractures includefracturesaffectingthemaxilla,thezygoma,andthenasoorbitaleth moidcomplex.Midfacialfractures canbeclassified as: • LeFort I (alsocalleda horizontal fracture) isa horizontal segmented fracture ofthe alveolar processofthemaxilla,inwhichtheteeth areusuallycontained inthedetached portionofthe bone.Resultis anopen bite. • LeFortII(alsocalledapyramidalfracture) isaunilateralorbilateralfractureofthemaxilla,in whichthebodyofthemaxillaisseparated fromthefacial skeleton andtheseparatedportion is pyramidal in shape. Signs include periorbital edema, ecchymosis, subconjunctival hemorrhage, and nose bleeding. • LeFort III (alsocalledatransverse fracture or craniofacialdysfunction)isafracture inwhich theentiremaxillaand oneor morefacial bones arecompletely separated from thecraniofa cialskeleton.These patients will have restriction of mandibular movement. • Also zygomaticomaxillary complex fractures, zygomatic arch fractures, or nasoorbital eth- moidfractures. Important:Thefirststepinthetreatmentofthesefractureswhichaffecttheocclusalrelationship issimilartothetreatmentofmandibularfractures- toreestablish aproperocclusal relationship byplacingthemaxillaintoproperocclusionwiththe mandible. Note: Duetotheslopeofthe sphenoid bonecomprising thefloor ofthecranialvault, blowsto themaxillawillcausethe maxilla to bedriven backwards and downwards.This may result in anopen bite or Impingementof the airway. Fractures ORAL SURGERY/PAIN CONTROL All of the following are weak points in the mandible where fractures are most com monexcept • Theangle • Thecoronoidprocess • Thecondylar neck • Thesymphysisarea Copyright©2001- DENTALDECKS
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