Resident Manual of Trauma to the Face, Head and Neck

Figure 5.15 Insufficient fixation of a mandibular fracture can result in fixation failure, infection, malocclusion, and nonunion. Lack of a tension band here allows muscle pull and occlusal forces to open the site.

d. Condyle y y All condylar fractures can be treated closed with MMF and/or with functional therapy using immediate function with elastics. y y Open access may be external, transoral, or transoral endoscopic- assisted ORIF. The endoscopic-assisted technique is similar in fixation, but requires a learning curve for fragment manipulation and one and two plate reduction strategies. y y Open techniques may require facial nerve protection using a facial nerve stimulator, or monitoring before induction of muscle relaxants during general anesthesia. y y Two techniques for plating are a single 2.0 mandibular plate with two screws on each side of the fracture, or two miniplates in triangular fashion, one below the sigmoid notch and one along the posterior border. y y Reduction and manipulation of the fracture are best accomplished with a mobile jaw. e. Additional Considerations i. Locking versus Nonlocking Plates Tightening screws on a malformed nonlocking plate will draw the bone segments toward the plate, which may affect the occlusion. Locking plates do not do this. They also preserve cortical bone perfusion and are unlikely to loosen from the plate. ii. Comminuted Fractures Reduce the main fragments by fixing them into occlusion with MMF. Then using miniplates, realign the comminuted fragments to establish bony continuity before placing the reconstruction plate if indicated.

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