What is an autogenous bone graft?
GOLD STANDARD graft
Could be harvested from local site e.g. chin or outer cortex of body of the mandible
E/O and I/O signs of a mandible #?
E/O
Facial asymmetry
Limited mandifbular movement
Tenderness TMJ
Deviation of mandible
Lacerations
Haematoma
2-point vertical mobility of the mandible
Contralateral numbness to the side of the impact
Ipsilateral numbness if the impact was distant tot eh extra-osseous mental nerve
I/O
Lacerations
Occlusal derangement
Loose or broken teeth
AOB
- Sublingual haematoma - really difficult to injure the FOM
Paraesthesia or numbness of lwoer teeth
signs of zygomatic #
- Subconjnctival haemorrhage
- Circum-orbital ecchymosis
- Flatness of the face
- Limitation of mouth opening - impinging on coronoid process
- Persistent numbness
- Diplopia
Limited eye movement
Classification of mandibular # - involvement of surrounding tissue
- Simple - fracture in the bone but surrounding soft tissue intact
- Compound - if fracture in bone and any laceration in surrounding tissue - directly exposed. Any fracture that involves the teeth is compound because the PDL is involved.
- Comminuted - when bone broken into multiple small pieces
Classification of mandibular # no. of #
single
double
multiple
Classification of mandibular # site
- Angle
- Sub-condylar
- Para-symphysial
- Body
- Ramus
- Coronoid
- Condylar fracture (intra
Alveolar process
Direction of the # line mandibular # - relates to the displacement
Favourable - if direction of # line minimises displacement
Unfavouorable - if direction of # line encourages displacement
what radiographs for mandibule #
2 radiographs at right angles to eo - (OPT/ CBCT + PA mandible)
Tx for a mandible #
Compound fractures require Ab
Reduction
- closed (do not open soft tissues)
- open reduction (surgery + internal fixation)
