General Principles of Mandible Fracture and Occlusion Workup

  • Author: Edward W Chang, MD, DDS; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jun 18, 2010
 

Laboratory Studies

  • Routine preoperative laboratory studies are ordered in preparation for surgery.
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Imaging Studies

  • A CT scan is extremely useful in maxillofacial trauma. Obtain images in both the axial and coronal planes.
  • A panoramic radiograph (Panorex) affords an excellent 2-dimensional representation of the mandible. The entire mandible and the dentoalveolar structures can be viewed with the Panorex. Historically, the symphyseal region was limited due to overlap wash out, but current orthopantograms give an excellent view of the mandible.
  • Several types of plain films add to the evaluation of mandibular fractures.
    • The dental periapical view gives fine detail to the teeth and their roots.
    • The dental occlusal view helps determine whether the fracture is vertically favorable or unfavorable. It delineates the medializing effects of the internal pterygoid posterior to the first molar and the mylohyoid anterior to the first molar.
  • The mandibular series includes several views to help identify the fracture.
    • The Caldwell is a coronal view that shows displacement in the horizontal plane.
    • The oblique views highlight the ramus angle and posterior body.
    • The reverse Towne view depicts the condylar/subcondylar region well.
  • Obtain a chest radiograph when evidence of a broken denture or missing tooth is present.
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Contributor Information and Disclosures
Author

Edward W Chang, MD, DDS  Consulting Staff, Department of Cosmetic Services, Head and Neck Surgery, Kaiser Permanente of Northern California at Santa Rosa

Edward W Chang, MD, DDS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and California Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Samuel M Lam, MD, FACS  Department of Otolaryngology, Facial Plastic Surgery, Presbyterian Hospital of Plano

Samuel M Lam, MD, FACS, is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery and International Society of Hair Restoration Surgery

Disclosure: Nothing to disclose.

Edward H Farrior, MD, FACS  Affiliate Associate Professor, Voluntary Faculty, Department of Otolaryngology-Head and Neck Surgery, University of South Florida Health Sciences Center; Visiting Clinical Associate Director, Department of Otolaryngology, University of Virginia

Edward H Farrior, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Florida Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

M Abraham Kuriakose, MD, DDS, FRCS  Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences

M Abraham Kuriakose, MD, DDS, FRCS is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, British Association of Oral and Maxillofacial Surgeons, and Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Dominique Dorion, MD, MSc, FRCSC, FACS  Program Director and Division Chair, Professor of Surgery, Division of Otolaryngology, University of Sherbrooke Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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  9. Eulert S, Proff P, Bokan I, Blens T, Gedrange T, Reuther J, et al. Study on treatment of condylar process fractures of the mandible. Ann Anat. 2007;189(4):377-83. [Medline].

  10. Schoen R, Fakler O, Metzger MC, Weyer N, Schmelzeisen R. Preliminary functional results of endoscope-assisted transoral treatment of displaced bilateral condylar mandible fractures. Int J Oral Maxillofac Surg. Feb 2008;37(2):111-6. [Medline].

  11. Coletti DP, Salama A, Caccamese JF Jr. Application of intermaxillary fixation screws in maxillofacial trauma. J Oral Maxillofac Surg. Sep 2007;65(9):1746-50. [Medline].

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  17. Chang EW, Lam SM, Karen M, Donlevy JL. Sliding genioplasty for correction of chin abnormalities. Arch Facial Plast Surg. Jan-Mar 2001;3(1):8-15. [Medline].

  18. Coleman JA, Johnson JT, Myers EN. Treatment of Mandibular Fractures. SIPAC;1995:13-109.

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  22. Kane AA, Lo LJ, Chen YR, et al. The course of the inferior alveolar nerve in the normal human mandibular ramus and in patients presenting for cosmetic reduction of the mandibular angles. Plast Reconstr Surg. Oct 2000;106(5):1162-74; discussion 1175-6. [Medline].

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Anatomy of the mandible.
Anatomy of the first molars.
Course of the facial nerve.
Facial incisions.
Intraoral access with identification of the mental nerve.
Favorable and unfavorable fractures. Top: Horizontal reference. Bottom: Vertical reference.
Top: Inferior compression plate. Bottom: Eccentric compression plate.
Maxillomandibular fixation using arch bars retained with composite resin.
Four point fixation for maxillomandibular fixation.
Radiograph of an oblique parasymphyseal fracture amenable to use the lag screw technique.
Reduction using the lag screw technique.
Fracture reduced with 2 screws used in the lag screw fashion.
Using percutaneous access in the difficult angle region.
When dentures are available, they can be used with the circummandibular wire technique.
When an infection or severe comminution is present, an external fixation device may be used.
A minimally displaced posterior mandible fracture.
Intraoperative view with external oblique ridge in view, situation ideal for Champy technique.
A monocortical plate configured in 2 dimensions to fit at the external oblique ridge.
Postoperative radiograph. Patient had an open reduction with internal fixation (ORIF) using the Champy technique and is not in maxillomandibular fixation.
 
 
 
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