Laboratory Studies

See the list below:

Routine preoperative laboratory studies are ordered in preparation for surgery.

Imaging Studies

See the list below:

A CT scan is extremely useful in maxillofacial trauma. Obtain images in both the axial and coronal planes.
A panoramic radiograph (Panorex) affords an excellent 2-dimensional representation of the mandible. The entire mandible and the dentoalveolar structures can be viewed with the Panorex. Historically, the symphyseal region was limited due to overlap wash out, but current orthopantograms give an excellent view of the mandible.
Several types of plain films add to the evaluation of mandibular fractures.
- The dental periapical view gives fine detail to the teeth and their roots.
- The dental occlusal view helps to determine whether the fracture is vertically favorable or unfavorable. It delineates the medializing effects of the internal pterygoid posterior to the first molar and the mylohyoid anterior to the first molar.
The mandibular series includes several views to help identify the fracture.
- The Caldwell is a coronal view that shows displacement in the horizontal plane.
- The oblique views highlight the ramus angle and posterior body.
- The reverse Towne view depicts the condylar/subcondylar region well.
Obtain a chest radiograph when evidence of a broken denture or missing tooth is present.

Treatment & Management

Ellis E 3rd, Walker LR. Treatment of mandibular angle fractures using one noncompression miniplate. J Oral Maxillofac Surg. 1996 Jul. 54(7):864-71; discussion 871-2. [QxMD MEDLINE Link].
Ellis E 3rd, Miles BA. Fractures of the mandible: a technical perspective. Plastic Reconstructive Surgery. December 2007. 120:76-89s.
Gibstein AR, Chen K, Nakfoor B, Gargano F, Bradley JP. Mandibular Subcondylar Fracture: Improved Functional Outcomes in Selected Patients with Open Treatment. Plast Reconstr Surg. 2021 Sep 1. 148 (3):398e-406e. [QxMD MEDLINE Link].
Natu SS, Pradhan H, Gupta H, Alam S, Gupta S, Pradhan R, et al. An epidemiological study on pattern and incidence of mandibular fractures. Plast Surg Int. 2012. 2012:834364. [QxMD MEDLINE Link]. [Full Text].
Kyrgidis A, Koloutsos G, Kommata A, Lazarides N, Antoniades K. Incidence, aetiology, treatment outcome and complications of maxillofacial fractures. A retrospective study from Northern Greece. J Craniomaxillofac Surg. 2013 Oct. 41(7):637-43. [QxMD MEDLINE Link].
Manson, PN. Facial fractures. Mathes, SJ. Plastic Surgery. 2nd. Philadelphia: Saunders Elsevier; 2006. Chapter 66, pp 77-380.
Scvhmidt BL, Kearns G, Gordon N, Kaban LB. A financial analysis of maxillomandibular fixation versus internal rigid fixation for the treatment of mandibular fractures. J Oral Maxillofac Surg. November 2000. 58(11):1206-10.
Shetty V, Atchison K, Leathers R, Black E, Zigler C, Belin TR. Do the benefits of rigid internal fixation of mandible fractures justify the added cost? Results from a randomized controlled trial. J Oral Maxillofac Surg. November 2008. 66(11):2203-12.
Kaura S, Kaur P, Bahl R, Bansal S, Sangha P. Retrospective Study of Facial Fractures. Ann Maxillofac Surg. 2018 Jan-Jun. 8 (1):78-82. [QxMD MEDLINE Link]. [Full Text].
El-Anwar MW. Changing Trends in the Treatment of Mandibular Fracture. Int Arch Otorhinolaryngol. 2018 Jul. 22 (3):195-196. [QxMD MEDLINE Link]. [Full Text].
Miles BA, Potter JK, Ellis E 3rd. The efficacy of postoperative antibiotic regimens in the open treatment of mandibular fractures: a prospective randomized trial. J Oral Maxillofac Surg. April 2006. 64(4):576-82.
Erstad BL, Kopp BJ, Tang AL. Antibiotic prophylaxis for traumatic facial fractures. J Clin Pharm Ther. 2021 Sep 6. [QxMD MEDLINE Link]. [Full Text].
Abdel-Galil K, Loukota R. Fractures of the mandibular condyle: evidence base and current concepts of management. Br J Oral Maxillofac Surg. 2010 Oct. 48(7):520-6. [QxMD MEDLINE Link].
Darwich MA, Albogha MH, Abdelmajeed A, Darwich K. Assessment of the Biomechanical Performance of 5 Plating Techniques in Fixation of Mandibular Subcondylar Fracture Using Finite Element Analysis. J Oral Maxillofac Surg. 2015 Nov 24. [QxMD MEDLINE Link].
Li Z, Zhou Z, Li P, Zeng W, Qing H, Tang W. Retrospective Study on Multidrug-Resistant Bacterium Infections After Rigid Internal Fixation of Mandibular Fracture. J Oral Maxillofac Surg. 2015 Nov 6. [QxMD MEDLINE Link].
Mizuhashi H, Suga K, Uchiyama T, Oda Y. Changes in mechanical properties of poly-l-lactic acid mini-plate under functional load simulating sagittal splitting ramus osteotomy. Int J Oral Maxillofac Surg. 2008 Feb. 37(2):162-9. [QxMD MEDLINE Link].
Valiati R, Ibrahim D, Abreu ME, Heitz C, de Oliveira RB, Pagnoncelli RM. The Treatment of Condylar Fractures: to open or not to open? A critical review of this controversy. Int J Med Sci. 2008. 5(6):313-8.
Eulert S, Proff P, Bokan I, Blens T, Gedrange T, Reuther J, et al. Study on treatment of condylar process fractures of the mandible. Ann Anat. 2007. 189(4):377-83. [QxMD MEDLINE Link].
Schoen R, Fakler O, Metzger MC, Weyer N, Schmelzeisen R. Preliminary functional results of endoscope-assisted transoral treatment of displaced bilateral condylar mandible fractures. Int J Oral Maxillofac Surg. 2008 Feb. 37(2):111-6. [QxMD MEDLINE Link].
Coletti DP, Salama A, Caccamese JF Jr. Application of intermaxillary fixation screws in maxillofacial trauma. J Oral Maxillofac Surg. 2007 Sep. 65(9):1746-50. [QxMD MEDLINE Link].
[Guideline] Barker DA, Oo KK, Allak A, Park SS. Timing for repair of mandible fractures. Laryngoscope. June 2011. 121(6):1160-3.

Media Gallery

Anatomy of the mandible.
Anatomy of the first molars.
Course of the facial nerve.
Facial incisions.
Intraoral access with identification of the mental nerve.
Favorable and unfavorable fractures. Top: Horizontal reference. Bottom: Vertical reference.
Top: Inferior compression plate. Bottom: Eccentric compression plate.
Maxillomandibular fixation using arch bars retained with composite resin.
Four point fixation for maxillomandibular fixation.
Radiograph of an oblique parasymphyseal fracture amenable to use the lag screw technique.
Reduction using the lag screw technique.
Fracture reduced with 2 screws used in the lag screw fashion.
Using percutaneous access in the difficult angle region.
When dentures are available, they can be used with the circummandibular wire technique.
When an infection or severe comminution is present, an external fixation device may be used.
A minimally displaced posterior mandible fracture.
Intraoperative view with external oblique ridge in view, situation ideal for Champy technique.
A monocortical plate configured in 2 dimensions to fit at the external oblique ridge.
Postoperative radiograph. Patient had an open reduction with internal fixation (ORIF) using the Champy technique and is not in maxillomandibular fixation.

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Author

Edward W Chang, MD, DDS, FACS Consulting Staff, Department of Cosmetic Services, Head and Neck Surgery, Kaiser Permanente of Northern California at Santa Rosa

Edward W Chang, MD, DDS, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American College of Surgeons, California Medical Association, American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Edward H Farrior, MD, FACS Affiliate Associate Professor, Voluntary Faculty, Department of Otolaryngology-Head and Neck Surgery, University of South Florida Health Sciences Center; Visiting Clinical Associate Director, Department of Otolaryngology, University of Virginia

Edward H Farrior, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Florida Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Dominique Dorion, MD, MSc, FRCSC, FACS Dean, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Université de Sherbrooke, Canada

Dominique Dorion, MD, MSc, FRCSC, FACS is a member of the following medical societies: Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

M Abraham Kuriakose, MD, DDS, FRCS Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences

M Abraham Kuriakose, MD, DDS, FRCS is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, British Association of Oral and Maxillofacial Surgeons, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Acknowledgements

Samuel M Lam, MD, FACS Department of Otolaryngology, Facial Plastic Surgery, Presbyterian Hospital of Plano

Samuel M Lam, MD, FACS, is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery and International Society of Hair Restoration Surgery

Disclosure: Nothing to disclose.