SURGICAL TREATMENT OF ISOLATED AND COMBINED MANDIBLE FRACTURES

Abstract

The observations conducted by the authors showed that of 285 patients with craniofacial combined injury 107 (male-91, female-16) had mandibular (lower jaw) fractures.According to the mandibular fracture combinations with other facial bones and craniocerebral injuries, mandibular fracture combined with cerebral injuries (40%), mandibular fracture combined with craniocerebral injury is very rare (12%), simultaneous injuries of mandible and other facial bones is always concomitant with cranio-cephalic injuries of different severity (48%).For treatment of mandibular fractures, surgery was suggested as the treatment of choice  by the authors - open repositioning and fixation of fractured fragments by Titanium miniplates and screws under nasotracheal general anesthesia.For  approach  to  mandibular  condylar  fracture line  an intraoral  incision  has  been  used.  At  fracture  of condylar  processes  (especially  when  a  small  piece  of fragment  is dislocated  out  of the  fossa), to provide free direct approach  to the fractured fragment after surgical treatment and to prevent facial nerve traumatic damage has been applied the following approach: after isolation/detachment of skin-fat segment from the mastication muscle, muscle dissection was done not at the edge of its mandibular fixation but at the border of its upper and middle third. Having detached the upper segment of muscle from the bone the area of mandibular joint is free for direct approach and nerve branches, nerve branches are not damaged. Dislocated joint head fractured fragment was returned to the  fossa and fixation to mandibular branch was performed by Titanium miniplates and screws.In the mandibular body and angle area, an intraoral incision approach  to  mandibular  condylar  fractures is considered as more cosmetic providing a firm and accurate fixation of the fragments.  Surgical treatment used for mandibular condylar fractures prevents facial nerve traumatic damage, ensures proper observation of the damaged area and makes it possible to provide a firm and accurate fixation of the fragments.