How do you fix a broken jaw?
The mandible (lower jaw) is a frequent site for fractures (breaks) due to accidents, assaults or sometimes underlying pathology (disease). Just as with other bones in the body, there are a myriad of methods for repairing this broken bone.
We characterize fractures as being open, that is, exposed to air inside the mouth or outside the facial skin or closed, that is, completely covered by soft tissue . Fractures can further be characterized as complete (the bone is broken completely into two or more pieces) or incomplete (the bone behaves like a green stick, fracturing only partway through and bending on the opposite side). Finally if the fracture is composed of many pieces it is termed "comminuted".
There are three steps in the repair of most fractures.
1.Reduction of the fracture - This step involves realigning the bony parts in their original anatomic relationship. Temporary holding devices may be utilized to assist in this endeavor. Reduction may be accomplished in an open (the fracture is visibly inspected) or closed (the fracture is not visualized) fashion.
2. Fixation of the fracture- This step uses various methods and materials (see below) to hold the bony parts in their correct relationship while healing occurs. The choice of what method of fixation to use depends on a number of factors including but not limited to the nature of the fracture, the physical status of the patient, concommitant injuries, psychosocial factors and cosmetic concerns.
Perhaps the simplest method of reduction and fixation is what oral and maxillofacial surgeons term maxillomandibular fixation (MMF) but most people know as "wiring the jaw shut. Many fractures are amenable to this form of treatment. With an intact dentition and a stable upper jaw, maxillomandibular fixation allows the upper jaw to act as a "cast" for the lower jaw while it heals.
A second type of fixation is termed "internal fixation". In this case wires and/or screws and plates are placed in the bony segments to hold them in their correct relationship. If the arrangement of hardware is rigid enough, this may be all the fixation required but in other cases, the internal hardware is used primarily to orient the fractured segments and MMF is still utilized to immobilize these segments so they can heal. This internal hardware may be applied from either an intraoral (inside the mouth) or an extraoral (outside the mouth) approach depending upon the clinical situation.
Occasionally there are clinical situations when an external fixation device other than MMF is required. In these cases, surgical "pins" are placed in the bony fragments and a stabilization device is placed between the pins to fixate the bony fragments in their proper orientation.
3.Healing and Rehabilitation - This last stage is a most important one. While "Mother Nature" plays an integral role, the role of the patient - following post operative care instructions, performing physical therapy exercises, assuring adequate nitrition and rest, avoiding deleterious substances such as alcohol, tobacco and recreational drugs - is also pivotal.
Copyright Kim E. Goldman, D.M.D. 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005
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