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54 Cards in this Set

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Which type of fracture resists upward displacing muscular forces when viewed in a horizontal plane?
HORIZONTALLY Favorable fractures.
Which type of fracture resists the medial pull of the medial pterygoid on the proximal fragment when viewed in the vertical plane?
VERTICALLY Favorable fractures
With a bilateral parasymphyseal fracture, the actions of what muscles put the patient in danger?
Digastric and Suprahyoid muscles pulling the segment posteriorly
What is the term for the portion of the mandible detached by bilateral parasympyseal fractures?
Flail segment
Any fracture limited to the tooth-bearing area?
Denotalveolar fracture
A fracture running in a vertical direction in the midline of the mandible
Symphysis fracture
A fracture found between the lateral mandibular incisor anteriorly and the mandibular foramen posteriorly
Parasymphyseal fracture
Any fracture between the mandibular foramen anteriorly and the distal aspect of the 2nd molar posteriorly
Mandibular body fracture
A fracture extending horizonatally through both the anterior and posterior borders of the ramus OR vertically from the sigmoid notch to the inferior border of the mandible
Ascending ramus fracture
What are the 2 types of fractures most likely to be considered Simple fractures? Why?
Ramus and Condyle fractures because they generally do not communicate with the exterior
A fracture that has not torn through the mucosa and is not associated with a laceration can still be considered what kind of fracture?
A compound fracture because it may be associated with the periodontal ligament.
A fracture that only goes through one cortex, and not the other, most commonly seen in children?
Greenstick fracture
How can a fracture be classified as complex or complicated? That's personification!
Implies damage to structures adjacent to the bone such as major vessels, nerves, or joints. Think IA canal or mental foramen
What are the two possible names for a fracture in which one fractured segment is forcibly wedged into the other?
1) Telescoped
2) Impacted
A type of fracture that occurs with normal forces applied to weakened bone.
Pathologic fracture
What class of drugs is commonly associated with anterior dislocation of the mandible? (jaw is stuck open)
Phenothiazines
What are the most common sites of mandible fracture? In order from greatest to least!
1. Mandibular body
2. Condyle
3. Angle
4. Symphysyeal region
5. Coronoid process
6. Alveolar body
What patients are Gunning splints used in?
Edentulous patients
What are the major indications for open reduction of a fractured mandible?
1. Unfavorable or unstable fractures (remember : horizontally or vertically)
2. Parasymphyseal fractures
3. Prolonged delay in txt
4. Complex facial fractures
5. Medically compromised pts.
6. Condylar fracture associated with another mandible fracture
What are the types of medically compromised patients in whom you would consider ORIF vs. CRIMF?
1. Those with decreased pulmonary function
2. Patients with GI disorders
3. Epileptics
4. Patients with psychiatric disorders
What are the Absolute indications for open reduction of a condylar fracture? (FFEM)
1. Foreign body within with capsule
2. Fracture into the middle cranial fossa
3. Extracapsular dislocation
4. Mechanical stop present
OR, if you can't bring the teeth into occlusion for CRIMF, but that's a copout answer.
Know the relative indications for ORIF of a condylar fx. They are on page __ of Petersons
Page 419 or page 19 of 34 in the computer file version.
What is another name for an Essig wire?
A bridle wire
What can you use to achieve closed reduction and fixation in edentulous patients?
Gunning splints
What are the indications for open reduction of mandible fractures?
1. Unfavorable/Unstable fx
2. Prolonged delay in txt
3. Concurrent condylar fx associated with mandible fx
4. Complex facial fx
What are some general contraindications to ORIF of mandible fx?
1. If there's a simpler way to treat the fx
2. Gunshot wounds
3. Fractures with small comminuted segments
Which type of mandible fracture is best treated with open reduction? why?
Parasymphyseal fractures because of the pull of the suprahyoid and digastric muscles
When doing an endoscopic approach to a condylar fracture, what type endoscope is used?
A 4 mm, 30° endoscope
Why extract teeth in the line of fracture?
1. Loose teeth; gross pathology like caries or perio
2. Partially erupted 3rds with periorcoronitis or cyst
3. Teeth prevent reduction of fx
4. With fractured roots
5. Tooth with exposed apices
6. Delay in txt
What percentage of fractures end up with delayed or nonunion?
3%
Which bacterial species are most commonly found in mandibular fractures?
Alpha hemolytic Strep and Bacteroides species
Whaht percentage of fractures result in permanent mental nerve injury?
8%
What percentage of pediatric patients suffer growth disturbance after condylar fractures?
25%
!
Internal derangement is more common in which population post-mandible fx? adults or children
Adults
Ankylosis is more common in which population post-mandible fx? Adults or children
Children
What groups of patients are at greatest risk of ankylosis?
1. Patients under the age of 10
2. Intracapsular fractures with fracture dislocation and telescoping
3. Compound, comminuted fractures
What is the most significant neurovascular structure to be aware of when doing a vestibular approach to the mandible?
The mental foramen: mental nerve, artery, vein
What type of innervation does the mental nerve provide?
Sensory to the skin and mucosa of the lower lip, skin in the region of the chin, facial gingiva of the ant. teeth
How many main branches does the mental nerve have?
3, one to the skin of the chin, the others to the mucosa and gingiva
Where would you incise to encounter the facial artery and vein during surgery?
Through the periosteum in the region of the mandibular antegonial notch
What is the only structure that lies between the facial vessels and bone?
Periosteum. Significance is that if you are dissecting, best to do it subperiosteal in the antegonial region to avoid these vessels
What is the significance of the mentalis muscle to facial expression?
It is the only elevator of the lower lip and chin
What nerve innervates the mentalis? Is it the mental nerve?
NO! The mentalis is innervated by the marginal mandibular branch of the facial nerve.
When extending a vestibular incision posteriorly, why would you incise no higher than the mandibular occlusal plane?
To avoid the buccal fat pad, as well as the buccal artery and nerve
In what region of the mandible is in NOT acceptable to close in just one layer?
In the anterior region because you have to re-attach the mentalis to avoid ptosis of the lip and chin
What is another name for the submandibular approach to the mandible?
The Risdon approach
Why is it important to incise the mandible at least 1.5cm below the inferior border of the mandible during a Risdon appproach?
Because in 19% of cases, the marginal mandibular branch lies below the inferior border of the mandible
What vein does the facial vein empty into?
The facial vein joins with the retromandibular vein to become the internal jugular vein
What layers do you initially incise through with the Risdon approach?
The skin and the submucosa
Why do you undermine and then resect the platysma? Why not just go for it?
The platysma lies just superior the the superficial layer of the deep cervical fascia which you do NOT want to haphazardly incise
What fascial layer makes up the capsule of the submandibular gland?
The superficial layer of the deep cervical fascia
What is the significance of the node of Stahr in this surgical approach?
The node of Stahr is a submandibular lymph node that alerts the surgeon to the presence of the facial artery
At what point on the mandible is there only periosteum anterior and pterygomasseteric sling?
At the premasseteric notch
What is the most avascular portion of the pterygomasseteric sling and thus the best portion to incise thru?
The inferior portion