Much less known than the axial skeleton, fractures of the facial skeleton, especially the jaw, must be recognized and diagnosed by any physician or dentist, based on sound knowledge of anatomy, history taking and clinical examination and simple radiology. Surgical treatment of these lesions, the authors argue, are spring specialist, and in recent years have seen a miniaturization of the implants for osteosynthesis and consequently a change in surgical approach routes. Endobucales have increased access to the detriment of the cervical tract, they say, thus enabling better patient function and comfort as well as a decrease in complications of trauma and surgery.
The simplified classification of mandibular fractures 7 regions concerned topographical condyle (the most common), coronoid, ramus, angle, body (or horizontal branch), and alveolar-dental symphysis. Three quarters of mandibular fractures are for male persons, mostly young, and the etiology varies with geographical location, being the main cause of interpersonal violence in urban centers, and traffic accidents in nonurban areas.
Anamnesis and clinical examination
As with any trauma examination is necessary to determine the date, type, direction and energy of the trauma. The history is aimed at the targeted location of pain and, especially, the existence of a subjective problem of occlusion. The review must be sought extra oral plates, bruises or signs of bruising, asymmetry, pain or loss of function and sensory-motor problems.
Endobucal examination, meanwhile, can reveal problems of dental occlusion, false mobility or crepitus in the fracture, bruising or gingival mucosa. Must be assessed mouth opening and mandibular excursion, and the possible trauma or tooth avulsions. The essential sign of mandibular fractures is the alteration of the occlusion or dental articulation. While it may be absent, non-displaced condylar fractures, their presence are an indicator of an underlying fracture.
Paraclinical tests
The panoramic radiograph radiographic examination is essential for any suspected fractures. Computed tomography has indicated the urgency, the authors, unless it is required for other craniofacial fractures.
Treatment
Mandibular fracture in the tooth area is a surgical emergency, say the authors, be regarded as an open fracture, because bacterial contamination by saliva that infiltrates the focus is the rule. In these patients, intravenous antibiotics should be given prior to surgical treatment and within 6 hours of injury. Those that do not involve the tooth area (such as the condylar or ascending branches) can be treated as deferred, although the rapid onset of treatment is advisable for the comfort of the patient. In these cases, they add, does not impose preoperative chemotherapy.
Treatment goals include restoration of mandibular function and aesthetic recovery. The indications for mandibular osteosynthesis, lists are open fractures and tooth area, dislocated fractures, complex, comminuted, infected pan facial in edentulous patients or those who refuse to cooperate or in which the blockade maxillomandibular is contraindicated, as is the case of epilepsy. The latter procedure is indicated, they say, mandibular fractures in children, with little in the condylar displacement and in those cases where there was a delay for the indication of internal rigid osteosynthesis. The progress that has allowed the internal rigid osteosynthesis are the abolition of the risks of extubation and the discomfort associated with maxillomandibular fixation, immediate mobilization and rapid functional recovery and the improvement of hygiene endobucal, among others.
Epidemiology
Plurifocal fractures is not uncommon, in a number of authors, 449 mandibular fractures were observed in 287 patients, giving an average figure of 1.56 fractures per patient. The median age is 30.6 years, with values ranging from 2 to 90 years? 75% of cases are male persons, and condylar fractures are most common. Traffic accidents are the leading cause of these fractures, a series evaluated by the authors indicated, however, that in the last ten years the incidence of this cause of mandibular fracture has decreased, while there was an increase of accidents Sports origin and the relative stability of aggression fractures.
Discussion
The mandible, its anatomy and its suspended position is exposed to multiple traumas, as the maxilla and zygomatic arches, participates in the neurocranium protection against a frontal impact. The condyles, in particular, the authors note, may be considered the "fuse" to protect the occipital fossa. Technically, the treatment of simple jaw fractures has evolved with the adoption of rigid internal osteosynthesis, which has gradually supplanted the traditional maxillomandibular blockade. The material currently used in the osteosynthesis (titanium) means a remarkable progress for its biocompatibility and small size. Thanks to the progress of these materials is now possible to use most often endobucales approach routes, avoiding visible external scarring and improves patient comfort. The traditional approach cervicotomy reserves only for certain complex fractures. Techniques in constant progression, the authors conclude, is capable of reducing complications and particularly the rapid recovery of function and the decline of the socioeconomic costs associated with this type of injury.
Translation and Adaptation: Gerardo Rodriguez Plans
Source: Sociedad Iberoamericana de Information Scientific
The simplified classification of mandibular fractures 7 regions concerned topographical condyle (the most common), coronoid, ramus, angle, body (or horizontal branch), and alveolar-dental symphysis. Three quarters of mandibular fractures are for male persons, mostly young, and the etiology varies with geographical location, being the main cause of interpersonal violence in urban centers, and traffic accidents in nonurban areas.
Anamnesis and clinical examination
As with any trauma examination is necessary to determine the date, type, direction and energy of the trauma. The history is aimed at the targeted location of pain and, especially, the existence of a subjective problem of occlusion. The review must be sought extra oral plates, bruises or signs of bruising, asymmetry, pain or loss of function and sensory-motor problems.
Endobucal examination, meanwhile, can reveal problems of dental occlusion, false mobility or crepitus in the fracture, bruising or gingival mucosa. Must be assessed mouth opening and mandibular excursion, and the possible trauma or tooth avulsions. The essential sign of mandibular fractures is the alteration of the occlusion or dental articulation. While it may be absent, non-displaced condylar fractures, their presence are an indicator of an underlying fracture.
Paraclinical tests
The panoramic radiograph radiographic examination is essential for any suspected fractures. Computed tomography has indicated the urgency, the authors, unless it is required for other craniofacial fractures.
Treatment
Mandibular fracture in the tooth area is a surgical emergency, say the authors, be regarded as an open fracture, because bacterial contamination by saliva that infiltrates the focus is the rule. In these patients, intravenous antibiotics should be given prior to surgical treatment and within 6 hours of injury. Those that do not involve the tooth area (such as the condylar or ascending branches) can be treated as deferred, although the rapid onset of treatment is advisable for the comfort of the patient. In these cases, they add, does not impose preoperative chemotherapy.
Treatment goals include restoration of mandibular function and aesthetic recovery. The indications for mandibular osteosynthesis, lists are open fractures and tooth area, dislocated fractures, complex, comminuted, infected pan facial in edentulous patients or those who refuse to cooperate or in which the blockade maxillomandibular is contraindicated, as is the case of epilepsy. The latter procedure is indicated, they say, mandibular fractures in children, with little in the condylar displacement and in those cases where there was a delay for the indication of internal rigid osteosynthesis. The progress that has allowed the internal rigid osteosynthesis are the abolition of the risks of extubation and the discomfort associated with maxillomandibular fixation, immediate mobilization and rapid functional recovery and the improvement of hygiene endobucal, among others.
Epidemiology
Plurifocal fractures is not uncommon, in a number of authors, 449 mandibular fractures were observed in 287 patients, giving an average figure of 1.56 fractures per patient. The median age is 30.6 years, with values ranging from 2 to 90 years? 75% of cases are male persons, and condylar fractures are most common. Traffic accidents are the leading cause of these fractures, a series evaluated by the authors indicated, however, that in the last ten years the incidence of this cause of mandibular fracture has decreased, while there was an increase of accidents Sports origin and the relative stability of aggression fractures.
Discussion
The mandible, its anatomy and its suspended position is exposed to multiple traumas, as the maxilla and zygomatic arches, participates in the neurocranium protection against a frontal impact. The condyles, in particular, the authors note, may be considered the "fuse" to protect the occipital fossa. Technically, the treatment of simple jaw fractures has evolved with the adoption of rigid internal osteosynthesis, which has gradually supplanted the traditional maxillomandibular blockade. The material currently used in the osteosynthesis (titanium) means a remarkable progress for its biocompatibility and small size. Thanks to the progress of these materials is now possible to use most often endobucales approach routes, avoiding visible external scarring and improves patient comfort. The traditional approach cervicotomy reserves only for certain complex fractures. Techniques in constant progression, the authors conclude, is capable of reducing complications and particularly the rapid recovery of function and the decline of the socioeconomic costs associated with this type of injury.
Translation and Adaptation: Gerardo Rodriguez Plans
Source: Sociedad Iberoamericana de Information Scientific
