1 Treatment topenlarge
Apply arch bars in the mandible and maxilla.
Reduce the bony deformity as far as possible in a closed manner prior to putting the patient into occlusion. Apply intermaxillary ligatures to maintain the occlusal position.
The patient has to be maintained in MMF for at least 6-8 weeks.
Pearl: individual laboratory designed arch bars
After taking impressions individual arch bars can be fabricated on plaster of paris casts. Prior to the arch bar fabrication these casts are sawed and the fracture is reduced (see blue zone on the cast).
Thus, the arch bar helps in the reduction. Furthermore, individual arch bars prevent damage of the periodontal soft tissues and are less invasive.
2 Case example topenlarge
Patient presents left mandibular body comminuted fracture.
Acceptable preoperative occlusion despite complex fracture.
OPG depicts the extent of bone comminution.
Axial CT views
Coronal CT sections.
3-D CT view of the same fractures.
The patient underwent MMF with arch bars and wires. Photograph shows the postoperative occlusion.
OPG shows fracture after treatment.
Stable occlusal result 7 weeks after treatment.
Mouth opening 7 weeks after treatment.
OPG shows consolidation in process 8 weeks after treatment.