1) Diagnosis and evaluation of patient:

a) History taking:
 Accurate detail and proper history of patient should be taken.
 If the patient is unable to give statement then the same should be recorded from
accompanying person, relative, friends or police officers.
 If will reveal about how the injury occurred, the type of injury and the severity
of the injury.
b) General Examination:
 It should be carried out to look for any serious injury elsewhere in the body so
that the appropriate specialist could be consulted.
 Inspection and palpation of head for any soft tissue as well as bone injury.
 Inspection and palpation of chest and abdomen for any injury.

c) Regional Examination:
The mouth and the face should be carefully cleaned for a proper examination.
 Extra oral :
-Inspection - Palpation
 Intra oral
- Inspection - Palpation
d) Radiological examination:
 Extra-oral Radiograph:
 P/A view of mandible in open mouth position
 Right and left lateral oblique view.
 X-ray for TMJ in both opened and closed mouth position
 OPG.
 Occlusal vies
2) Definitive treatment:
(i) Conservative treatment: (When only fracture line seen but no displacement then
conservative Rx done).
a) Control of pain- A patient of fracture of mandible experiences extreme degree
of pain and may go into shock because of service into lerable pain so IV
Diazepam can be given in the does of 10 mg combined with (15-30)mg
pentazocine as analgesics.

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 b) Control of infection- Prevention of infection is of outmost importance so,
antibiotics should be prescribed.
c) Temporary stabilization of fractured part temporary splinting of the fractured
fragments with the help of barrel bandage. Temporary stabilization in the form of
horizontal wiring is and effective procedure.
d) Soft diets.
e) Oral hygiene Instructions:
f) Advice to the patient that he / she shouldn’t move the jaw vigorously.
g) Follow-up.

ii) Active treatment / principles of treatment: (if displacement occur then active
Rx. done).

Reduction: It is the process of bringing the fractured fragments into alignment

normal Position.
Types:
Closed reduction:
It is usually done in simple fracture.
1. Whenever closed reduction is possible the risk of subsequent infection of the
fracture is negligible.
2. Precise anatomical reduction is not necessary in fracture of denture bearing
area.
3. Pulls or manipulate the bone under the intact skin until the fracture is in
proper position.

Open reduction:
1. If tooth remains undamaged, potentially functional should be retained with
antibiotic administration.
2. If tooth is damaged & not functional.

Fixation:
It is the procedure by which the fractured bone ends are fixed in reduced position.
a) Indirect fixation by IMF
b) Direct fixation by bone plate, screws.

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 Immobilization:
The reduced and fixed fragments of the bone are immobilized for certain period
for healing to occur.
Fixation and immobilization are achieved together by the means of IMF or with
the help of bone plates and screws.

Rehabilitation / Physiotherapy:

Treatment plan:

Intracapsular Extracapsular
Unilateral: IMF (7- Bilateral: IMF (7-
Unilateral: 10) Days. (Not 10) Days, (Not
Bilateral Active
Active necessary if not necessary if not
Children movement No.
movement No. displaced) displaced
IMF
IMF Followed by active Followed by
movement. active movement.
IMF (4-6) weeks
Occlusion OK IMF(3-4) weeks Open SOS.
No. IMF IMF only at IMF-4 weeks open Intermittent IMF:
Adult
Painful Joint night with SOS. 48 hours IMF
IMF-2 weeks. elastics-4 Weeks then open then 24
hours IMF.

TIME OF IMMOBILIZATION OF FRACTURED MANDIBLE

Period of immobilization depends upon the site of fracture, presence or retained teeth in
fracture line, age of patient and presence and absence of infection.

A simple guide to the time of immobilization for the fracture of tooth bearing area of the
lower jaw is follows:
Young adult with fracture of the angle receiving early treatment in which tooth removed
for the fracture line = 3 weeks.

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If :
a) Tooth retained in the fracture line, add 1 week.
b) Fracture at the symphysis, add 1 week
c) Age 40 years & over, add 1 or 2 weeks.
d) Children or adolescents; subtract 1 week.

Applying this guide it follows that a fracture of the symphysis in 40 years old patient
when the tooth in the fracture line is retained requires 6 weeks immobilization (Basic 3
weeks) one week for less favorable site + one week allowed for age+1 week for tooth
retained in the fractured line.)

Methods of immobilization:
A) Intramaxillary Fixation:
i) Dental wiring
* Direct wiring / Glimmer’s direct method of wiring
* Eyelet wiring / lvy Eyelet wiring/ Interdental eyelet wiring.

ii) Arch bar wiring

iii) Splints: Cast metal splint, Acrylic cap splint.
iv) Circumferential wiring.

B) Intermaxillary fixation with Osteosynthesis:

i) Direct Intra-Osseous wiring / Trans-osseous wiring
Upper border intra-osseous wiring
Lower border intra-osseous wiring
Figure 8 wiring
Four hole system
Two hole system
ii) Transfixation with Kirschner’s wiring
iii) External pin Fixation
iv) Bone clamps
v) Implants/ Grafts.

 MAHMUD CD9