Resident Manual of Trauma to the Face, Head and Neck

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.

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Resident Manual of Trauma to the Face, Head, and Neck