eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Trauma

Mandibular Body Fractures: Follow-up

Author: Jose E Barrera, MD, Clinical Faculty, Department of Otolaryngology-Head and Neck Surgery, Wilford Hall Medical Center
Coauthor(s): Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Contributor Information and Disclosures

Updated: Nov 11, 2008

Outcome and Prognosis

Both closed and open reductions of mandibular fractures cause favorable results for bony union. In a study of 922 mandibular body and angle fractures treated with an intraoral approach without IMF, solid bony union was achieved in more than 99% of patients.5

Rarely does a second fracture following additional assault or vehicular accident occur. However, when it does happen, the cause for the second fracture is usually an assault, with 90% related to alcohol intake. Angle, body, and parasymphysis regions of the mandible were the most common sites to be involved in the first occasion.

In a study with 10 cases, an internal rigid fixation procedure was performed for the treatment of a secondary fracture. In the recurrent injuries, none of the fractures occurred at exactly the same anatomical site. Fractures were either in the neighboring side or in the contralateral side of the previously healed area of the mandible. On the second occasion, angle fractures were common, but body and subcondylar fracture rates increased. At second presentation, the complication rate increased from 23.1% to 53.8% and most commonly involved malocclusion.

Future and Controversies

Controversy exists over open versus closed reduction for angle fractures. Traditionally, MMF has been the mainstay of treatment. Plating techniques have revolutionized open reduction as a treatment modality.

Advantages of closed reduction include proven efficacy, low complication rate, and short operating time. This technique may be performed as an office procedure. Disadvantages include long fixation (ie, 3-6 wk), poor nutrition associated with MMF, risk of TMJ ankylosis, and airway problems.

Advantages to ORIF include earlier mobilization and nearly exact bone fragment reapproximation. Disadvantages include increased treatment cost and need for operating room time.

Another controversy involves disposition of teeth located in the fracture line. In the postantibiotic era, infection of involved teeth is less troublesome. Many teeth may be retained, and they can be useful in reduction and stabilization of fractured segments. Extract teeth if they prevent proper reduction and fracture stability or if they have significant periodontal disease or caries.

 


More on Mandibular Body Fractures

Overview: Mandibular Body Fractures
Workup: Mandibular Body Fractures
Treatment: Mandibular Body Fractures
Follow-up: Mandibular Body Fractures
Multimedia: Mandibular Body Fractures
References
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References

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

  2. Kuriakose MA, Fardy M, Sirikumara M, et al. A comparative review of 266 mandibular fractures with internal fixation using rigid (AO/ASIF) plates or mini-plates. Br J Oral Maxillofac Surg. Aug 1996;34(4):315-21. [Medline].

  3. Ellis E 3rd, Price C. Treatment protocol for fractures of the atrophic mandible. J Oral Maxillofac Surg. Mar 2008;66(3):421-35. [Medline].

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

  5. Luhr HG, Hausmann DF. [Results of compression osteosynthesis with intraoral approach in 922 mandibular fractures]. Fortschr Kiefer Gesichtschir. 1996;41:77-80. [Medline].

  6. Alpert B, Engelstad M, Kushner GM. Invited review: small versus large plate fixation of mandibular fractures. J Craniomaxillofac Trauma. Fall 1999;5(3):33-9; discussion 40. [Medline].

  7. Barber HD, Woodbury SC, Silverstein KE. Mandibular fractures. In: Oral and Maxillofacial Trauma. Philadelphia, Pa: WB Saunders Co; 1991:473-526.

  8. 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. Nov 2004;62(11):1392-5. [Medline].

  9. Gardner KE, Aragon SB. The mandibular fracture. In: ENT Secrets. Philadelphia, Pa: Hanley & Belfus; 1996:302-309.

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

  11. Lazow SK. The mandible fracture: a treatment protocol. J Craniomaxillofac Trauma. Summer 1996;2(2):24-30. [Medline].

  12. Schilli W, Stoll P, Bahr W. Mandibular fractures. In: Manual of Internal Fixation. New York, NY: Springer-Verlag; 1990:65-80.

  13. Spiessel B. The stability principle. In: Internal Fixation of the Mandible: A Manual of AO/ASIF Principle. New York, NY: Springer-Verlag; 1989:30-45.

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Further Reading

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Keywords

mandible, mandibular body fractures, mandible body fractures, mandible fractures, mandible fracture, jaw fracture, broken jaw, horizontal ramus fracture, mandibular fracture, mandibular surgery, jaw fracture

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Contributor Information and Disclosures

Author

Jose E Barrera, MD, Clinical Faculty, Department of Otolaryngology-Head and Neck Surgery, Wilford Hall Medical Center
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, and 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 College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Hassan H Ramadan, MD, MSc, Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University
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, and American Rhinologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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 College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

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 unstricted gift unknown

 
 
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