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

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

Mandible - Symphysis and parasymphysis, complex

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Glossary

1 Treatment top

Closed reduction for symphyseal fractures enlarge

Arch bars are applied to the teeth and MMF is secured. The patient is monitored using x-rays for positional changes of the mandibular ramus. At 6 weeks MMF is released and fracture stability determined by manipulation. The patient is placed on a soft diet and if the occlusion maintains for 2 weeks the arch bars may be removed.

Note: in complex fractures, the period of MMF may need to be increased up to 8 weeks or more.

2 Case example top

Closed treatment of complex symphyseal fractures enlarge

Diagnosis

Panoramic and PA view of a minimally displaced comminuted symphyseal/body fracture in an adolescent patient.

Note: treatment of a simple or a basal triangle fracture would be no different.


Closed treatment of complex symphyseal fractures enlarge

Pretreatment occlusal relationship
A malocclusion is the result of this minimally displaced comminuted symphysis/body fracture.


Closed treatment of complex symphyseal fractures enlarge

Treatment

Closed reduction was selected for this patient mandibulomaxillary fixation (MMF) because the extended area of comminution would have required a large reconstruction plate being placed.


Closed treatment of complex symphyseal fractures enlarge

The patient did not object to a course of MMF and did not want a larger operation.


Closed treatment of complex symphyseal fractures enlarge

Postoperative x-rays

"Postoperative" x-rays following closed treatment and MMF show good alignment of bone fragments and reestablishment of occlusion.


Closed treatment of complex symphyseal fractures enlarge

Outcome

Patient underwent 5 weeks of MMF. Final occlusal photographs show restoration or normal occlusion.


Closed treatment of complex symphyseal fractures enlarge

Closed treatment of complex symphyseal fractures enlarge

Photograph shows rehabilitation of mouth opening.

v1.0 2008-12-01