Fundamentals of Mandible Fractures

Mandibular fractures are very common facial fractures among young working age population. Airway maintenance is a relevant point in the initial reception of trauma, although mandibular fractures rarely prevent proper management or intubation maneuvers. Although the clinical examination is important (occlusion alterations, facial format), CT scan, through axial and coronal slices, is the study of choice to assess the severity of the trauma and plan treatment. From the surgical point of view, fractures are classified into simple fractures (single, with good bone support, dentate patients) and complex fractures (comminuted fractures, with bone defect, infected, and in edentulous patients). The best time to treat a mandibular fracture is as soon as the patient is fit for surgery. Conservative treatment (intermaxillary fixation) is still an indication in simple fractures. Nevertheless, most mandibular fractures are resolved surgically, based on their complexity or patient needs. Both the transoral and extraoral accesses, as well as lacerations caused by trauma, are useful for reduction and fixation, depending on the anatomical location of the fractures. Depending on the complexity of the fracture, osteosynthesis systems allow the construction of load-sharing osteosynthesis (functional loads shared between implant and bone) or load-bearing osteosynthesis where the implant bears all the biomechanical loads. Condylar and subcondylar fractures have a precise indication for surgical resolution (dislocation, foreign body, impossibility of reduction, multiple trauma). In general, the impacted and uncomplicated third molar at an angular fracture line should not be removed initially.