Management of selected mandibular and maxillary fractures (Proceedings)
There are many techniques currently employed for Mandibular fracture repair. They range from simple tape muzzle placement to various forms of invasive surgical reduction. Surgical reduction techniques include intra oral wire cerclage or ligation, osseous plating, inter medullary pining to extra-oral fixation appliances or combinations thereof. These techniques require special instrumentation and added investment in equipment. They require longer surgical time to perform with added trauma and subsequent postoperative discomfort to the patient. The major complication with invasive Mandibular fracture reduction is post reduction dental malocclusion. Most surgical reductions, especially those that employ external fixation or plating tend to displace the fracture segments when they are secured. The clinician must be able to evaluate the alignment and occlusion of the mandible throughout the procedure.
Most reductions have been performed while the patient is conventionally intubated. This prevents occlusal evaluation during reduction. The mouth cannot be closed to evaluate dental or occlusal alignment due to interference from the endotracheal tube. To insure proper dental occlusion, Mandibular fracture reduction must be performed with pharyngeal-tracheal intubation or intravenous anesthesia with appropriate monitoring and support. These protocols permit occlusal evaluation during reduction without obstruction of the dental arcades by an endotracheal tube. The clinician is then able to place the mandible into proper occlusion at all times during the procedure.
Mandibular fracture reduction can be accomplished without invasive procedures with the use of inexpensive dental materials. These include forming wax or a like boxing material such as caulking compound, orthophosphoric acid, (enamel etching gel), dental acrylic and the new non-exothermic, chemically cured temporary dental composite materials.