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Mandibular Angle Fractures Workup

  • Author: Jose E Barrera, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Sep 25, 2015
 

Imaging Studies

See the list below:

  • The single most informative radiologic study used in diagnosing mandibular fractures is the panoramic radiograph.
    • Panorex provides the ability to view the entire mandible in one radiograph.
    • Panorex requires an upright patient, and it lacks fine detail in the TMJ, symphysis, and dental/alveolar process regions.
  • Plain films, including lateral-oblique, occlusal, posteroanterior, and periapical views, may be helpful.
    • The lateral-oblique view helps in diagnosing ramus, angle, or posterior body fractures. The condyle, bicuspid, and symphysis regions often are unclear.
    • Mandibular occlusal views show discrepancies in the medial and lateral position of the body fractures.
    • Caldwell posteroanterior views demonstrate any medial or lateral displacement of ramus, angle, body, or symphysis fractures.
  • CT scanning may also be helpful.
    • CT scanning allows physicians to survey for facial fractures in other areas, including the frontal bone, naso-ethmoid-orbital complex, orbits, and the entire craniofacial horizontal and vertical buttress systems.
    • Reconstruction of the facial skeleton is often helpful to conceptualize the injury.
    • CT scanning is also ideal for condylar fractures, which are difficult to visualize.
 
 
Contributor Information and Disclosures
Author

Jose E Barrera, MD Medical Director, Texas Facial Plastic Surgery and ENT; Associate Professor, Uniformed Services University of the Health Sciences; Clinical Associate Professor, University of Texas Health Science Center at San Antonio School of Medicine

Jose E Barrera, MD 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 Academy of Sleep Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen G Batuello, MD Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American Medical Association, Colorado Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Stephen G Batuello, MD Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American Medical Association, Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Hassan H Ramadan, MD, MSc Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society

Disclosure: Nothing to disclose.

References
  1. Pektas ZO, Bayram B, Balcik C, Develi T, Uckan S. Effects of different mandibular fracture patterns on the stability of miniplate screw fixation in angle mandibular fractures. Int J Oral Maxillofac Surg. 2012 Mar. 41(3):339-43. [Medline].

  2. Cole P, Rottgers SA, Cameron H, et al. Improving the minimally invasive approach to mandible angle repair. J Craniofac Surg. 2008 Mar. 19(2):525-7. [Medline].

  3. Hsueh WD, Schechter CB, Tien Shaw I, Stupak HD. Comparison of intraoral and extraoral approaches to mandibular angle fracture repair with cost implications. Laryngoscope. 2015 Jul 7. [Medline].

  4. Collins CP, Pirinjian-Leonard G, Tolas A, et al. A prospective randomized clinical trial comparing 2.0-mm locking plates to 2.0-mm standard plates in treatment of mandible fractures. J Oral Maxillofac Surg. 2004 Nov. 62(11):1392-5. [Medline].

  5. Pattar P, Shetty S, Degala S. A Prospective Study on Management of Mandibular Angle Fracture. J Maxillofac Oral Surg. 2014 Dec. 13 (4):592-8. [Medline].

  6. Al-Moraissi EA, Ellis E 3rd. What method for management of unilateral mandibular angle fractures has the lowest rate of postoperative complications? A systematic review and meta-analysis. J Oral Maxillofac Surg. 2014 Nov. 72 (11):2197-211. [Medline].

  7. Burm JS, Hansen JE. The use of microplates for internal fixation of mandibular fractures. Plast Reconstr Surg. 2010 May. 125(5):1485-92. [Medline].

  8. Dodson TB. Third molars may double the risk of an angle fracture of the mandible. Evid Based Dent. 2004. 5(3):78. [Medline].

  9. Katakura A, Shibahara T, Noma H, et al. Material analysis of AO plate fracture cases. J Oral Maxillofac Surg. 2004 Mar. 62(3):348-52. [Medline].

  10. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture patterns: a suburban trauma center experience. Am J Otolaryngol. 2004 Sep-Oct. 25(5):301-7. [Medline].

  11. Sadhwani BS, Anchlia S. Conventional 2.0 mm miniplates versus 3-D plates in mandibular fractures. Ann Maxillofac Surg. 2013 Jul. 3(2):154-9. [Medline]. [Full Text].

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A transverse fracture of the mandible angle without displacement. A: Transverse fracture of the right mandible with fixation using miniplates at the superior and inferior borders. B: Postoperative radiograph demonstrating fixation.
Forces acting on the mandible and the relationship between muscle pulls and fracture angulation. A: Horizontally unfavorable. B: Horizontally favorable. C: Vertically unfavorable. D: Vertically favorable.
Comminuted angular fracture of the left mandible. A: Transverse and longitudinal fractures. B: A lag screw and reconstruction plate used to provide fixation. C: Radiograph depicting fixation.
Comminuted fracture of the ascending mandibular ramus. A: A comminuted fracture of the left ascending ramus. B: Reduction using miniplates of the superior aspect of the ascending ramus. C: Bridging of the comminuted area using a reconstruction plate.
 
 
 
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