Fixation of Fractures Involving the Mandible, Maxilla, and Skull

Mandible fractures occur more frequently than maxilla fractures. More specific, hemimandibular fractures are more commonly encountered. In many cases, fracture follows grasping an object and setting back rapidly; however, these fractures can occur from kicks, falling over, or running into an immovable object. Pathologic fractures may be seen in progressive severe dental disease with chronic infection and osteolysis. On other occasions, tumors render the mandible fragile, predisposing it to fracture.

Facial asymmetry, excessive salivation, and localized swelling are commonly present. Radiographs provide a definitive diagnosis using multiple projections. For rostral fractures, intra-oral radiographs are indicated. Mandibular and maxillary fractures should always be considered open fractures. Fractures of the rostral mandible and maxilla are usually amenable to successful repair. This is attributable to: 1) an abundance of vascular supply and liberal soft tissue coverage; 2) the soft tissue attachments and bilaterally symmetrical mandibles provide excellent support for fractures; and 3) tension surfaces of the mandible and maxilla are on the oral side. Unilateral fractures often require minimal fixation because of the stability provided by the contralateral mandible. Unstable fractures or those resulting in malocclusion should be repaired; the simplest method of fixation usually satisfies the biomechanical requirements. […]