1 C J Mieny, U Mennen: Principles of Surgical Patient Care - Volume ...

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- oedema in the region of trauma- traumatic laterognathismVisual ExaminationExtra-Orally- laceration (generally small) and/or ecchimosis or hematoma in the region of thefracture- hemorrhage from the external auditory canal could indicate a fracture of the condylarhead and mandibular fossa or/and a fracture of the petrous bone (a cerebrospinal fluid leakor Battle's sign will confirm last-mentioned).Intra-Orally- step formation and displacement of parts of the dentition- traumatic diastema between the teeth and quite often the loss of a tooth in the lineof the fracture- laceration of the gingiva at the fracture site- oedema in the floor of the mouth with haematoma or echimosis.Palpation ExaminationExtra-Orally- Pain in the region of a direct fracture, but also in the area of the contre-coup fracture- step formation on the inferior border of the mandible- movement of the fragments.Intra-Orally- pain in the region of the fracture line- step formation may be created when the fragments are moved passively in a superoinferiorand in a bucco-lingual direction.Diagnosis and Special InvestigationsThe clinical signs as found in the visual and palpation examination are generallydiagnostic for the type and location of the mandibular fracture.40
Radiographs may reveal the extent, the precise location, the dental involvement andany dislocation due to muscular action on the fracture. The radiographs should always bemade and then also scrutinized in all three dimensions. For this purpose two standardradiographs should be taken, namely:- an orthopantomogram- a postero-anterior facial-skull radiograph.Certain areas of the mandible and skull base have to be radiographed more specificallyso that the exact location and extent of the fracture may be determined. These specializedradiographs are:- a Towne's radiograph for an antero-posterior view of the condyle neck and head- an occlusal or status X radiograph for the symphyseal and para-symphyseal areas- a lateral facial-skull or trans-cranial radiograph for the condylar neck and head, themandibular fossa region and the associated skull base- an oblique-lateral mandibular radiograph for the mandibular angle and also for whenan orthopantomogram is not possible.TreatmentThe basic principles in mandibular fracture treatment are:- accurate positioning and reduction of the fractured segment according to the dentalocclusion (six micrometers discrepancy will be felt by the patient as a major disturbance)- fixation of these segments over time so that the fracture may unite.Reduction and Fixation MethodsClosed Reduction and FixationThis is the least complicated way of reducing a fracture. The fracture must be simple,a greenstick or closed comminuted, class I or class III type, with little dislocation.The different types of treatment are:- a maxillo-mandibular (or intermaxillary) dental wiring is issued where there arenatural teeth present, an Ivy (fig. 5.3.17), Stout, Risdon, Obwegeser, etc. wiring may be done- arch stabilizers in the form of pre-fabricated metal arches (Erich, Jelenko, etc) areavailable, and usually used for a mandibular (and maxillary) dento-alveolar fracture41
Page 1 and 2: C J Mieny, U Mennen: Principles of
Page 3 and 4: informative and is easy to perform.
Page 5 and 6: 4. Larynx- Heimlich manoeuvre- Dire
Page 7 and 8: Chapter 5.2: Acute Infections of th
Page 9 and 10: Table 5.2.2. Treatment of Acute Oti
Page 11 and 12: DiagnosisOtoscopy will reveal tympa
Page 13 and 14: There are definite predisposing fac
Page 15 and 16: TreatmentAdequate bedrest and fluid
Page 17 and 18: Acute StomatitisAcute inflammatory
Page 19 and 20: although not dangerous in itself, c
Page 21 and 22: - motor-vehicle accidents- assaults
Page 23 and 24: The fracture line runs through the
Page 25 and 26: than that of the Le Fort II fractur
Page 27 and 28: Lateral or Supero-Lateral Orbital M
Page 29 and 30: Coronal tomography of the ethmoidal
Page 31 and 32: Haemorrhage and ShockSevere bleedin
Page 33 and 34: - laceration of the facial region-
Page 35 and 36: Le Fort III and Combined Le Fort Fr
Page 37 and 38: Surgical AnatomyThe mandible has a
Page 39: The "area of fracture" describes th
Page 44 and 45: In a case where sufficient soft-tis
Page 46 and 47: classical "moon face" swelling with
Page 48 and 49: After carefully doing this clinical
Page 50 and 51: 2. Thermal3. Caustic- Inhalation of
Page 52 and 53: Table 5.4.3. The Diagnostic Work-Up
Page 54 and 55: CommentLaryngotracheal TraumaS L Se
Page 56 and 57: Tracheotomies are classified as:- e
Page 58 and 59: Table 5.5.4. Etiology of Laryngeal
Page 60 and 61: Table 5.5.7. Conditions Leading to
Page 62 and 63: - The median raphe of the sternohyo
Page 64 and 65: CommentTracheotomyS L SellarsCondit
Page 66 and 67: - Examination of the anterior chamb
Page 68 and 69: maintained only if such injuries ar

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