ahmed zebari & zuhair zain
TRANSCRIPT
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Treatment Planning &Seminars
Case Presentation
Ahmed Amer Zebari 200910256
Zuhair AlZain 200911234
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* 79 Years old man, full denture user with
long standing controlled hypertensionsustained a fall on floor in toilet. He was
presented with pain while talking & inability
to open mouth wide.
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DIAGNOSIS OF FRACTURED
MANDIBLES
* History
(Past Medical History, Type and Direction
of Traumatic Force)
* Clinical Examination(extraoral &intraoral ecchymosis, Swelling,
pain and tenderness to palpation, etc)
* Radiographic Examination(OPG), mandible series radiograph and CT
scans can be used to diagnose and plan the
treatment
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Diagnostic Imaging:
The facial radiographic examination should depend to
some degree on the clinical examination and thesuspected injury.
The purpose of radiographs is to confirm thesuspected
clinical diagnosis & determine the extent of the injury.
Radiographic evaluation of the mandible requires two or
more of the following radiographic views :
- Panoramic view.
- Posterior Anterior View.
- Lateral Oblique view.
- CT scan.
- Towne's view.
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- PA view : Body Fracture - LO view: Angle Area Fracture
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- Towns View: Dis. Of Cond. Fracture. - Panoramic View: Dis. Fracture of body &
Subcondylar fracture
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Treatment Of Condyle:
- Some patients can be treated with a liquid to softdiet and careful follow-up evaluation.
- If malocclusion is present after periarticular edema
resolves, closed reduction is performed.
- Non-operative management of condylar fractures
can be used more liberally for edentulous patients,
who can tolerate moderate degrees of condylar
displacement. New dentures can compensate forthe change
in jaw relations.
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Treatment Options Of Condylar Fractures:1- No Treatment.
2- Closed Reduction.
3- Open Reduction.
4- Endoscopically Assisted.
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Treatment Options Of Condylar Fractures:1 - No Treatment:
No treatment is considered when no occlusal discrepancy or
Functional impairment exists.
2- Closed Reduction:
- Very high condylar neck fractures without dislocation.
- Intra-capsular Fractures.
Patient.Elderly-
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- Endoscopically Assisted:
_ It reduces the risk to the facial nerve and minimize
scaring.
_ Using intraoral approach, a Ramus incision is made
and the masseter muscle stripped to create the optical
cavity.
_ Under vision and with special instruments the fracture
is manipulated and reduced.
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Fractures of Edentulous Mandible:
- Resorption.- Aging process & bone structure.
- Cross-Sectional area.
- Type of Fracture.
- Trismus is a relatively
constant finding with
mandibular fractures.
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Atrophic edentulous Mandible mostly
fracture at the midbody, where the
atrophy is most advanced.
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Control Of Pain:
- If present : Give adequate
analgesia. ( Avoid giving
powerful analgesics, which
depress the level of
consciousness & respiration.
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Treatment for edentulous mandibular
fracture:
Methods of immobolization :
1- Indirect Skeletal Fixation: Gunning-type
splint.
2- Direct Skeletal Fixation :
A- Extra Oral Pin Fixation
B- Transosseos wiring.
C- Bone plating.
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