SYMPHYSIS AND CORPUS MANDIBLE FRACTURE
Mgs. Puji Wahid Farhan Muhammad
Ilmu Bedah, 2006624892
ANATOMY
SYMPHYSIS/PARASYMPHYSIS REGION
The symphysis/parasymphysis region is the single central
unit of the mandibular arch. Its lateral edges are
determined by the roots of the lower canines and thus this
region matches with the intercanine bone portion. For the
purpose of this classification, we will refer to it as the
symphysis region.
Two anterior transitional zones are defined along the
contours of the canine roots as vertical strips in the width
of the adjacent interdental spaces.
BODY REGION
The mandibular body refers to each of the lateral bony
regions between the canines and the angle.
In the dentate mandible, the anterior edge of the
mandibular body goes through the root of the lower
canines.
A fracture line fully located within the anterior
transitional zone is assigned to the respective body
region.
A fracture line in a body region extending into the
posterior transitional zone is considered confined to
the body region.
INCIDENCE
Symphysis and parasymphysis fracture accounts for 15 to 20%.
Body fractures are rare.
Overall, facial fractures in the pediatric population comprise less than 15% of all
facial fractures
They are rare below age 5 (0.6–1.4%) and their incidence rises as children begin
school.
Boy > Girl
Facial fractures in children occur less frequently than in adults and they are
more often minimally displaced.
ETIOLOGY
Road traffic accidents
(RTA) constitute the
Falls, Sports-related injuries
most frequent causes
of facial fractures.
Work-related accidents
or pathologic Bisphosphonate-
Tumors, and cysts
conditions such as related osteonecrosis,
osteoradionecrosis,
DIAGNOSIS
“My teeth don’t fit together.”
Soft tissue injuries, including
• Intraoral bruising,
• Gingival and
• Sublingual hematoma, and
• Dentoalveolar injuries
DIAGNOSIS Inspect the oral cavity for loose or missing
teeth.
• Any unaccounted for teeth may be loose in the wound, lost at
the scene, or aspirated.
• If you cannot account for a missing tooth an X-ray of the head
and chest should be done.
The oral lining should be inspected for
lacerations
the occlusion should be checked.
Palpation of the maxillary buttresses and
mandible may reveal fractures.
DIAGNOSIS
Excellent single test for mandibular fractures is
the panoramic radiograph.
The symphyseal region is best evaluated with a
plain, posteroanterior radiograph of the
mandible.
CT scan is frequently obtained in the
emergency center to evaluate facial trauma and,
as mentioned previously, is quite sensitive and
specific for detecting mandibular fractures, but
provides less information with regard to
dentition.
TREATMENT
Goal
Antibiotic
Restore the preinjury dental occlusion
Penicillin is most commonly recommended because it
Reduce the fracture, placing the segments in a normal
covers most oral bacteria, and
anatomical alignment and then preventing movement at
clindamycin recommended for patients with the fracture site until osseous union.
penicillin allergies
TREATMENT
Pediatric
Open or closed reduction and immobilization by splints and arch bars for 2
to 3 weeks.
Rarely, long-term mono-maxillary immobilization (via splinting) for up to 2
months is indicated to prevent malocclusion.
Mandibular fractures without displacement and malocclusion are managed
by close observation, a liquid to soft diet, avoidance of physical activities
(e.g. sports) and analgesics.
Displaced mandibular fractures need to be reduced and immobilized
(open reduction and rigid fixation).
When tooth buds within the mandible do not allow internal fixation with
plates and screws this can be achieved with a mandibular splint fixed to the
teeth by circum-mandibular wiring, gunning splint or a splint with MMF.
TREATMENT
Adult
Stable mandible fractures with no evidence of malocclusion can occasionally be treated
with a nonchew diet for a period of 4 to 6 weeks, depending on the age, state of
dentition, and compliance of the patient.
Immediate discomfort is relieved by temporary immobilization of the fracture with a
wire joining the teeth adjacent to the fracture site.
RIGID FIXATION Rigid fixation typically implies plates that accommodate
screws that are 2.4 or 2.7 mm in diameter.
Severely displaced fractures or with multiple mandible
fractures have lost more of the intrinsic stability of die
mandibular arch and may require fixation that is more
rigid and bears more of the functional mandibular load.
High risk for poor healing, such as those with atrophic
mandibles or established infection, usually benefit from
absolutely rigid fixation.
OPERATIVE
In severely displaced If the arch bars are
Should begin by re-
fractures, it may be applied initially without
establishing the patient's
beneficial to expose the preliminary reduction,
occlusion using
fracture first to achieve the arch bar itself may
maxillomandibular
some degree of initial lock the arch into a
fixation.
reduction. malocclusion.
BODY FRACTURE
• Pediatric
Inferior mandibular border can be plated, when the buds of the permanent premolar and molar
have migrated superiorly toward the alveolus.
BODY FRACTURES
• Adult
Mandibular body fractures are treated with either maxillomandibular fixation alone (for 4 to 6
weeks) or internal fixation.
Most practitioners prefer to perform an open reduction and internal fixation in these cases.
Care must be taken to avoid the mental nerve when placing the screws.
As with symphyseal fractures, all but the most severe fractures are treated using an intraoral
incision.
COMPLICATION
Malocclusion, usually secondary to maladaptation of the plate used for fixation.
Inappropriately contouring the plate (especially a large plate such as the 2- to 4-mm system)
results in the mandible shifting to adapt to the plate.
Infection is also a common complication of mandibular fractures, most often as a
consequence of mobility at the fracture site or because of loose hardware.
During the exploration of an infected fractures that had been previously repaired, the
operative site is thoroughly irrigated and the stability of the fixation assessed.
Culture-specific antibiotic therapy is instituted after an appropriate operative culture is
obtained.
REFERENCE
Cornelius, C. P., Audigé, L., Kunz, C., Rudderman, R., Buitrago-Téllez, C. H., Frodel, J., & Prein, J. (2014). The
comprehensive AOCMF classification system: mandible fractures-level 3 tutorial. Craniomaxillofacial trauma &
reconstruction, 7(1_suppl), 31-43.
Gurtner GC, Neligan PC. Plastic Surgery E-Book: Volume 3 Principles. 3rd ed. Elsevier Health Sciences; 2017
Sept 15.
