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Resident Manual of Trauma to the Face, Head, and Neck
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Chapter 5: Mandibular Trauma
a. Symphysis and Parasymphysis
y
y
Mandibular symphysis undergoes twisting (torsion) forces. Simple
fractures can be treated with arch bars and 6 weeks of MMF alone.
y
y
Wire osteosynthesis requires using 24-gauge (0.5-mm) inferior
boarder wire and MMF.
y
y
Plate osteosynthesis requires two straight plates or a reconstruction
plate. The farther apart (superior/inferior) the plates, the more stable
the fracture site.
y
y
Reduction can be assisted by inferior border wire or monocortical
screws/clamp.
y
y
Mental nerve and tooth root injury must be avoided.
b. Body
y
y
Simple body fractures can be treated with arch bars and 6 weeks of
MMF alone. They can also be treated with MMF with miniplate
fixation.
y
y
Wire osteosynthesis requires using 24-gauge (0.5-mm) superior
border wire and MMF.
y
y
Utilize multiple lag screw fixation of fractures in a saggital plane with
appropriate overlap.
y
y
Plate osteosynthesis requires two straight plates or a reconstruction
plate.
y
y
Complex fractures and edentulous fractures require reconstruction
plate fixation.
c. Angle
y
y
Simple fractures can be treated with arch bars and 6 weeks of MMF
alone.
y
y
Wire osteosynthesis requires using 24-gauge (0.5-mm) superior
boarder wire and MMF.
y
y
Champy showed that functional loading of a simple angle fracture
creates tension (distraction) on the upper border of the fracture and
is treated by a tension band. Failure to do this allows the fracture to
open (Figure 5.15). In the same regard, compression occurs on the
lower border during functional loading and stabilizes this portion of
the fractured bone. The Champy miniplate fixation technique extends
medial to lateral over the external oblique ridge. For additional
stability, a second inferior border plate via transcutaneous trocar
technique can be added to the Champy technique or to a superior
border plate.
y
y
Complex fractures may require reconstruction plate fixation.