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Quick Review #98 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast
When surgically repairing a symphyseal fracture of the mandible, prevention of splaying of the lingual cortex (where the lingual or tongue-side of the mandible splits apart) is important for stable fixation and proper healing.
1. Proper Reduction: Achieving and maintaining an accurate reduction of the fracture segments is essential. This can be done manually and with the assistance of reduction forceps.
2. Arch Bars and Intermaxillary Fixation: Before the placement of permanent fixation, the use of arch bars and intermaxillary fixation (wiring the jaws together) can help stabilize the fracture and maintain occlusion, which prevents displacement of the fracture segments.
3. Rigid Internal Fixation: Using plates and screws for rigid internal fixation can prevent splaying. The application of a lingual splint may be used in conjunction with plate fixation.
4. Placement of Plates: Appropriately placing the plates along the inferior border and superior border (alveolar process) can provide a buttressing effect. This technique is often referred to as “load-bearing” when placed along the inferior border and “load-sharing” when placed high on the alveolar process. In order to prevent lingual splaying with the placement of plates, it's important to consider over-adapting the plates to the buccal cortex, as under-adapting would directly cause lingual splaying.
5. Use of Lag Screws: Lag screws can be used to compress fracture segments together. The screw passes through one fractured bone fragment into another without engaging the threads in the first fragment, which pulls the fragments together as the screw is tightened.
6. Monocortical vs. Bicortical Screws: In some cases, monocortical screws (screws that engage only one cortical plate) may be preferred to bicortical screws (screws that engage both the buccal and lingual cortical plates) to avoid lingual cortex splaying.
7. Tension Band: A tension band can be placed on the superior aspect of the mandible to counteract the muscles that pull the lingual cortex medially.
A thorough understanding of mandibular anatomy, the mechanism of injury, and the principles of fracture management are crucial for successful outcomes.
References:
1. Ellis, E., & Moos, K. F. (1993). Assessment of internal fixation devices for mandible fractures. Journal of Oral and Maxillofacial Surgery, 51(7), 754-760.
2. Fonseca, R. J., Walker, R. V., Betts, N. J., Barber, H. D., & Powers, M. P. (2000). Oral and Maxillofacial Trauma (Vol. 2). W.B. Saunders. ISBN: 072167894X
3. Haug, R. H., Fattahi, T. T., & Goltz, M. (2002). A biomechanical evaluation of mandibular symphysis fracture plating techniques. Journal of Oral and Maxillofacial Surgery, 60(6), 642-649.
4. ChatGPT. 2024.