Definition
Mandible fractures are described according to their
localization (see diagram):
1 Alveolar process fracture
2 Lateral (paramedian) mandible fracture
3 Mandibular angle fracture
4 Corpus fracture
5 Mandibular fracture
6 Collum and capitulum fracture
7 Fracture of the Muscular
process
Therapy Goals
The aim of the therapy is to restore form and function
of the mandible. Special emphasis is put on the restoration
of the occlusion and the function of the motoric and/
or sensory nerves. Furthermore, infections are to be prevented,
pain alleviated and the duration of the disease reduced.
Therapy Indications
For the therapy indication, we have to differentiate between
closed and open fractures (with laceration of the oral mucosa
and/ or teeth in the site of the fracture). Open fractures
should be treated immediately for infection prophylaxis.
Clinical indication for a mandible fracture
Radiological evidence of a mandible fracture
Malocclusion
Dysfunction
Sensory and/ or motoric nerve dysfunction (inferior alveolar
nerve, mental nerve, lingual nerve, facial nerve)
Mobile fracture fragments
Continuity defect
Xenolith
Soft tissue injuries or injuries of other bone structures
Heavy bleeding
Acoustic meatus injury
Examinations
Inspection
Palpation
Vitality test
Aesthesiometry
Functional test of the facial nerve
2nd levelx-ray
Computer tomography in multiple fractures
Casting and modeling of the maxilla and mandible which serve
as setups for repositioning with occlusion control and, if
necessary, for the production of individually fitted splints
Therapy
A mandible fracture can be treated conservatively or
surgically. The choice of therapy is influenced by
the following factors:
Single or multiple fracture(s)
Fracture stability
Necessity for early mobilization (e.g. associated collum fractures)
Associated injuries (e.g. soft tissue injuries) which need
surgical treatment
Continuity defects
Patient’s age
Patient’s compliance and cooperation
Conservative Therapy
Surveillance over a period
Diet, depending on fracture stability (e.g. mashed food or
fluids)
Closed fracture repositioning
Immobilization
Functional
therapy
Picture 5: Diagram. In a collum fracture which is not
displaced the maxilla and mandible are ‘joined together’
(= maxilla-mandible-fixation)
Surgical Therapy
In an open reposition the fracture is normally prepared under
anesthesia and, after repositioning, stabilized with plates
(=osteosynthesis). Absorbable plates or titanium plates can
be used. The choice of material depends on the type of fracture
and the patient’s compliance and oral hygiene.
Recommendation
Normally the treatment has to be in hospital. Outpatient
treatments are rarely indicated.
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