Mandibular Symphyseal and Parasymphyseal Fractures Workup

  • Author: William D Clark, MD, DDS; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Feb 24, 2012
 

Laboratory Studies

No lab studies are needed to evaluate these fractures; however, they may be indicated in the evaluation of associated injuries.

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Imaging Studies

  • Computed tomography (CT) scans have become the criterion standard for evaluating the mandible for fractures.
  • In patients with multiple traumas, many emergency departments obtain near whole-body CT scans, which may provide useful information.
  • The panoramic dental radiograph is an excellent tool for imaging the traumatized mandible. When the needed equipment is not available or the patient cannot be placed in the apparatus, plain radiographs of the mandible may be sufficient.
  • Three-dimensional reconstructions of CT scans can be useful to evaluate complex mandibular fractures. The ultimate imaging tool is the stereolithographic model, which some centers are able to make from CT scan images. These are life-size models of the facial bones made of a plastic resin that can be handheld. They can be useful in planning treatment and may be used as templates for contouring rigid hardware or constructing splints and other adjunctive appliances.
  • Evaluation of the entire mandible is important because multiple fractures are common. If the blow was directed at the anterior arch of the mandible, excluding fractures of the subcondylar areas is mandatory.
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Contributor Information and Disclosures
Author

William D Clark, MD, DDS  Chief of Pediatric Otolaryngology, University of Texas Health Science Center San Antonio

William D Clark, 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 Academy of Pediatrics, American College of Physicians, American Society for Head and Neck Surgery, and American Society of Pediatric Otolaryngology

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and American Rhinologic Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, 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 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, 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; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

  1. Barber HD, Woodbury SC, Silverstein. Mandibular fractures. In: Oral and Maxillofacial Surgery. Vol 1. 2nd ed. 1997:473-526.

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

  3. Ji B, Wang C, Liu L, Long J, Tian W, Wang H. A biomechanical analysis of titanium miniplates used for treatment of mandibular symphyseal fractures with the finite element method. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Mar 2010;109(3):e21-7. [Medline].

  4. Gerbino G, Boffano P, Bosco GF. Symphyseal mandibular fractures associated with bicondylar fractures: a retrospective analysis. J Oral Maxillofac Surg. Aug 2009;67(8):1656-60. [Medline].

  5. Clark WD. Management of mandibular fractures. Am J Otolaryngol. May-Jun 1992;13(3):125-32. [Medline].

  6. Clark WD, Simko EJ. Mandibular fractures. In: Gates GA, ed. Current Therapy in Otolaryngology. Philadelphia: Mosby; 1998:150-152.

  7. Motamedi MH. An assessment of maxillofacial fractures: a 5-year study of 237 patients. J Oral Maxillofac Surg. Jan 2003;61(1):61-4. [Medline].

  8. Sabesan T, Peters WJ, Townend M. Lower border reducer for symphyseal and parasymphyseal fractures of mandible: a new device. Br J Oral Maxillofac Surg. Oct 2006;44(5):418. [Medline].

  9. Yerit KC, Hainich S, Enislidis G, et al. Biodegradable fixation of mandibular fractures in children: stability and early results. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jul 2005;100(1):17-24. [Medline].

 
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The broad red line indicates the symphyseal area. The pink area between the cuspid teeth, excepting the symphysis, indicates the parasymphyseal area.
The model on the left shows comminuted fractures. The model on the right has been repaired to facilitate preoperative contouring of a reconstruction plate.
Opposing lag screws have been used to treat a symphyseal fracture. This procedure requires precise technique and is not for the occasional operator.
Two miniplates are required for the symphysis/parasymphysis region because it is subjected to torsional forces, which would be poorly resisted by one miniplate.
Tension banding is required to prevent splaying of the fracture line at the superior surface of the mandible when using a dynamic compression plate. A mandibular arch bar can accomplish this. In this example, a miniplate is used.
 
 
 
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