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.

Treatment & Management

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. [QxMD MEDLINE Link].
Brucoli M, Boffano P, Pezzana A, et al. The "European Mandibular Angle" Research Project: The Epidemiologic Results From a Multicenter European Collaboration. J Oral Maxillofac Surg. 2019 Apr. 77 (4):791.e1-.e7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Ribeiro-Junior PD, Vago TM, da Silva WS, Padovan LEM, Tiossi R. Mandibular angle fractures treated with a single miniplate without postoperative maxillomandibular fixation: A retrospective evaluation of 50 patients. Cranio. 2017 May 29. 1-9. [QxMD MEDLINE Link].
Brucoli M, Boffano P, Pezzana A, et al. The "European Mandibular Angle" research project: the analysis of complications after unilateral angle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Jul. 128 (1):14-7. [QxMD MEDLINE Link].
Falci SGM, de Souza GM, Fernandes IA, Galvao EL, Al-Moraissi EA. Complications after different methods for fixation of mandibular angle fractures: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2021 Mar 3. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Burm JS, Hansen JE. The use of microplates for internal fixation of mandibular fractures. Plast Reconstr Surg. 2010 May. 125(5):1485-92. [QxMD MEDLINE Link].

Media Gallery

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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Author

Jose E Barrera, MD Medical Director, Texas Center for Facial Plastic and Laser Surgery; Clinical 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 College of Surgeons

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Stryker, LLC.

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.

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; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Hassan H Ramadan, MD, MSc, FACS, FARS Professor and Chairman, Director of Rhinology and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc, FACS, FARS 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.

Mandibular Angle Fractures Workup

Imaging Studies

References

Tables

Contributor Information and Disclosures

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