Executive Editor: Marcelo Figari, Gregorio Sánchez Aniceto General Editor: Daniel Buchbinder

Authors: Ricardo Cienfuegos, Carl-Peter Cornelius, Edward Ellis III, George Kushner

Mandible

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Glossary

Symphysis and parasymphysis, simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed treatment (MMF) Non- or minimally displaced simple fractures in compliant patients with good dentition amenable to MMF. Basic surgical experience, no specialized skills Basic equipment only
ORIF, two lag screw fixation Oblique or sagittal fractures where two lag screws can be placed from the buccal or lingual cortices. Some specialized surgical experience Full specialized surgical and imaging resources
ORIF, lag screw and plate Oblique or sagittal fractures where only one lag screw is possible. The plate is used to supplement the fixation. Some specialized surgical experience Full specialized surgical and imaging resources
ORIF, one plate and arch bar Simple fractures when used in combination with a stable arch bar. Basic surgical experience, no specialized skills Basic equipment only
ORIF, two plates Cases where an arch bar is not possible because of missing teeth, loose teeth, or the objection to using an arch bar, or distal trailing fractures not amenable to the other treatments. Basic surgical experience, no specialized skills Basic equipment only

Symphysis and parasymphysis, complex

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed treatment Non- or minimally displaced complex fractures in compliant patients with good dentition amenable to MMF. Basic surgical experience, no specialized skills Basic equipment only
ORIF, two plates (basal triangle) If control of the top of the basal triangle is required, the use of two plates provides this control. Some specialized surgical experience Simple surgical and imaging resources
ORIF, reconstruction plate (basal triangle) Maximum stability under load bearing conditions. Some specialized surgical experience Simple surgical and imaging resources
ORIF, reconstruction plate (comminuted fracture) Standard method of treatment of a comminuted fracture. Some specialized surgical experience Simple surgical and imaging resources
External fixator Temporary stabilization of complex fractures simultaneously affecting several anatomic mandibular subunits. Some specialized surgical experience Full specialized surgical and imaging resources

Body, simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Seldom indicated for non-mobile non-displaced fractures with undisturbed occlusion. Basic surgical experience, no specialized skills Basic equipment only
Closed treatment Non- or minimally displaced simple fractures in compliant patients with good dentition amenable to MMF. Basic surgical experience, no specialized skills Basic equipment only
ORIF, lag screws Sagittal/oblique fractures Some specialized surgical experience Simple surgical and imaging resources
ORIF, one miniplate Simple fractures in compliant patients with good dentition and buttressing of the segments after reduction. Basic surgical experience, no specialized skills Basic equipment only
ORIF, two plates Simple fractures in transitional areas of the mandibular body. Some specialized surgical experience Simple surgical and imaging resources
ORIF, one large plate Reduced bone buttressing requiring load bearing fixation. Some specialized surgical experience Full specialized surgical and imaging resources

Body, complex

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed treatment In rare cases, in compliant patients with good dentition and non- or minimally displaced fractures. Basic surgical experience, no specialized skills Basic equipment only
ORIF, two plates (basal triangle) Basal triangle fracture. Some specialized surgical experience Simple surgical and imaging resources
ORIF, reconstruction plate Standard method of treatment of a comminuted fracture. Some specialized surgical experience Simple surgical and imaging resources
External fixator Temporary stabilization of complex fractures simultaneously affecting several anatomic mandibular subunits. Some specialized surgical experience Full specialized surgical and imaging resources

Angle and ramus, simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Seldom indicated for non-displaced non-mobile fractures in a compliant patient with normal occlusion. Basic surgical experience, no specialized skills Basic equipment only
Closed treatment Non- or minimally displaced favorable fractures of the angle in compliant patients with good dentition amenable to MMF. Basic surgical experience, no specialized skills Basic equipment only
ORIF, wire In unfavorable fractures when plate/screw fixation is not available. Some specialized surgical experience Basic equipment only
ORIF, miniplate fixation to the oblique ridge Standard method of treatment of isolated simple mandibular angle fractures. Some specialized surgical experience Simple surgical and imaging resources
ORIF, two miniplates Conditions when use of a secondary plate improves bone buttressing and fracture alignment. Some specialized surgical experience Simple surgical and imaging resources
ORIF, reconstruction plate Reduced bone buttressing requiring load bearing fixation. Some specialized surgical experience Full specialized surgical and imaging resources

Angle and ramus, complex

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed treatment Non- or minimally displaced favorable fractures of the angle in compliant patients with good dentition amenable to MMF. Basic surgical experience, no specialized skills Basic equipment only
ORIF, two plates (basal triangle) If control of the top of the basal triangle is required, the use of two plates provides this control. Some specialized surgical experience Simple surgical and imaging resources
ORIF, reconstruction plate (basal triangle) Maximum stability under load bearing conditions. Some specialized surgical experience Simple surgical and imaging resources
ORIF, reconstruction plate (comminuted fracture) Standard method of treatment for comminuted fractures requiring load-bearing fixation. Some specialized surgical experience Full specialized surgical and imaging resources
External fixator Temporary stabilization of complex fractures simultaneously affecting several anatomic mandibular subunits. Some specialized surgical experience Full specialized surgical and imaging resources

Condylar process and head, simple and complex

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Non- or minimally displaced fractures in compliant patient. Basic surgical experience, no specialized skills Basic equipment only
Closed treatment Standard method of treatment for non-dislocated or minimally displaced fractures in compliant patients with good dentition and amenable for MMF. Basic surgical experience, no specialized skills Basic equipment only
ORIF, one/two plate(s) - extraoral approach Displaced fractures resulting in shortening of the ramus height or when the fracture segment interferes with normal mandibular function. Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF, one/two plate(s) - intraoral approach Low condylar process fractures. Some specialized surgical experience Full specialized surgical and imaging resources
ORIF, one/two plate(s) - endoscopically assisted Higher condylar process fractures amenable to an intraoral approach with endoscopic assistance. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Multiple fractures
Edentulous atrophic fractures
Teeth in the line of fracture
Involvement of alveolar area
Infected fractures with or without bone loss
Coronoid process fractures
Complications
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2008-12-01