Mandible Fractures: Consensus and Controversy | Journal CME Article-Journal CME Article: Mandible Fractures: Consensus and Controversy (Article)

Journal CME Article: Mandible Fractures: Consensus and Controversy (Article)

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Mandibular fractures are among the most common facial fractures requiring operative treatment. They result from causes like falls, assaults, motor vehicle collisions, sports, and ballistic trauma, with variation in incidence by geography and population. Proper management is critical to prevent complications such as infection, pain, malocclusion, or dysfunction.<br /><br />A clear understanding of mandibular anatomy—including distinct regions (symphysis, parasymphysis, body, angle, ramus, condyle), tooth positions, nerve pathways (inferior alveolar, mental, lingual, and marginal mandibular nerves), and muscle attachments—is essential for accurate diagnosis and treatment planning. The temporomandibular joint allows unique mandibular mobility, influencing treatment decisions, especially in condylar fractures.<br /><br />Initial patient evaluation includes trauma surveys, assessing occlusion, nerve function, and imaging, with CT scans now preferred for fracture characterization. Social determinants impacting outcomes should be considered.<br /><br />Treatment decisions hinge on fracture displacement and malocclusion: nondisplaced fractures without malocclusion often require nonoperative management (soft diet, pain control), while displaced or malocclusive fractures typically need surgical intervention. Maxillomandibular fixation (MMF) is used to reestablish occlusion, with various techniques such as Erich arch bars, hybrid arch bars, interdental wiring, or IMF screws, each with pros and cons regarding application time, stability, hygiene, and tooth/root protection.<br /><br />Surgical access may be intraoral or extraoral (e.g., the Risdon approach), with selection depending on fracture location, complexity, and need for visualization. Fixation methods follow two main philosophies: load-bearing (AO technique using larger, rigid plates with bicortical screws) and load-sharing (Champy technique using miniplates with monocortical screws near teeth). The choice depends on fracture complexity, bone quality, patient factors, and compliance.<br /><br />Management of condylar fractures is particularly controversial: open reduction and internal fixation can improve occlusion and pain but carry risks to facial nerve and infection; closed treatment with MMF is common for nondisplaced fractures. Teeth in the fracture line present additional treatment dilemmas; extraction is typically reserved for teeth with root fractures or blocking reduction; otherwise, preservation with stabilization is preferred.<br /><br />Postoperative care promotes soft diet, pain control, hygiene, and gradual return to function. Complications include infection, nonunion, and hardware failure, with smoking as a significant modifiable risk factor.<br /><br />In summary, mandibular fracture management involves nuanced decisions regarding operative necessity, fixation techniques, nerve preservation, and postoperative care. While consensus exists on several principles, controversies remain in antibiotic use, condylar fracture treatment, fixation method choice, and dentition management, warranting further research and individualized care.

Keywords

Mandibular fractures

Facial trauma

Operative treatment

Mandibular anatomy

Temporomandibular joint

Maxillomandibular fixation

Load-bearing fixation

Load-sharing fixation

Condylar fracture management

Postoperative care