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Home Documents lbm 4 blok Post on Oct 82 views. It is the one serious facial bone injury that the average practicing dental surgeon may expect to encounter, albeit on rare occasions, at his surgery. It is also a facial fracture which he may have the misfortune to cause as a complication of tooth extraction.

Fractures with no gross communition of the bone and without significant loss of hard and soft tissues 2. Fractures with gross communition of the bone and with extensive loss of both hard and soft tissues. Mylohyoid line to body of hyoid Digastric muscle: Compound Fractures of tooth bearing portions of the mandible, into d mouth via the periodontal membrane and at times through the overlying skin.

Communited Usually compound fractures characterized by fragmentation of bone Pathological Results from an already weakened mandible by pathological conditions.

Oikarinen and Lindqvist studied patients with multiple injuries sustained in RTA. The most common facial fractures were in the mandible. Studies have shown that the incidence of mandible fractures are influenced by various etiological factors e.

Geography Social trends Road traffic legislations Seasons Oikarinen and Malmstrom analyzed mandible fractures. On analysis the following results were obtained: Body of mandible Even though the body of the mandible has the highest incidence when it comes to mandibular fracture, the condyle remains the commonest site for mandibular fracture Bleeding from the mouth. Bilateral condylar fractures Same as above Limitation in mouth opening Restricted mandibular movement Anterior open bite Essential Extra-oral Radiographs Oblique lateral radiographs left and right Fracture of body proximal to canine region Fractures of angle, ramus and condylar region Posterior-anterior view Shows displacement of fractures in the ramus, angle, body Rotated posterior-anterior view Fractures between Symphysis and canine region Reverse Townes view Ideal for showing lateral or medial condylar displacement Essential Intra-oral Radiographs Periapical radiographs: Association of tooth to line of fracture Existing pathology related to tooth in line of fracture Fracture of tooth in line of mandibular fracture Occlusal radiographs: Association of root of tooth to line of fracture Desirable Radiographs Panoramic tomography represents the best single overall view of the mandible especially the condyles Standard linear tomography Computed tomography CT Closed reduction Immobilization To allow bone healing Through fixation of fracture line 1.

Bone Healing Primary bone healing: No fracture callus forms Heals by a process of 1. Haversian remodeling directly across the fracture site if no gap exists Contact healingor 2. Deposition of lamellar bone if small gaps exist Gap healing Requires absolute rigid fixation with minimal gaps Bone Healing Secondary bone healing: Bony callus forms across fracture site to aid in stability and immobilization Occurs when there is mobility around the fracture site Bone Healing Secondary bone healing involves the formation of a sub periosteal hematoma, granulation tissue, then a thin layer of bone forms by membranous ossification.

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Hyaline cartilage is deposited, replaced by woven bone and remodels into mature lamellar bone The fracture is compound into the mouth via the opened periodontal membrane 2. The tooth may be damaged structurally or loose its blood supply as a result of the trauma so that the pulp subsequently becomes necrotic 3. The tooth may be affected by some pre-existing pathological process Indications for removal Absolute Relative Absolute indications Longitudinal fracture involving the root Dislocation or subluxation of tooth from socket Presence of periapical infection Infected fracture line Acute pericoronitis Relative indications Functionless tooth which would eventually be removed electively Advanced caries Advanced periodontal disease Teeth involved in untreated fractures presenting more than 3days after injury Management of teeth retained in fracture line Good quality intra-oral periapical radiograph Appropriate antibiotic therapy Splinting of tooth if mobile Endodontic therapy if pulp is exposed Immediate extraction if fracture becomes infected Site of fracture 2.

Presence of retained teeth in the line of fracture 3. Age of the patient 4. Presence or absence of infection A simple guide to time of immobilization for fractures of the tooth bearing area of the mandible is as follows: Young adult with Fracture of angle Receiving Early treatment In which Tooth removed from fracture line 3 weeks Non-compression small plates Compression plates Mini plates Lag screws Intermaxillary fixation with Osteosynthesis 1.

Trans osseous wiring Circumferential wiring External pin fixation Bone clamps Transfixation with kirschner wires Nondisplaced favorable fractures 2.

Mandibular fractures in children with developing dentition 3. Short procedure time 3. Can be done in clinical setting with local anesthesia or sedation 4.

Not absolute stability secondary bone healing 2. Oral hygiene difficult 3. Arch bars Erich arch bars 2. Intermaxillary fixation screws 5.

Cervical Vertigo – [DOC Document]

Fracture of Edentulous mandible Influencing factors: Decreased inferior alveolar artery centrifugal blood flow 2. Dependent on periosteal centripetal blood flow 3. Medical conditions that delay healing 4. Decreased ability to heal with age 5. Altered physical characteristics following tooth loss Circumferential wiring Indirect skeletal fixation 1.

Bone clamps Intermaxillary fixation using gunning type splints 1. Combined with other techniques Ini adalah salah spesivik cedera tulang wajah serius yang rata-rata berlatih dokter gigi dapat berharap untuk menemukan, meskipun pada kesempatan langka, di operasi nya. Ini juga merupakan fraktur wajah yang ia mungkin memiliki kemalangan untuk menyebabkan komplikasi pencabutan gigi.

Patah tulang tanpa communition kotor tulang dan tanpa kehilangan keras dan lunak jaringan 2. Patah tulang dengan communition kotor tulang dan dengan hilangnya luas dari kedua jaringan keras dan lunak. Persarafan CN3; saraf mandibularis melalui foramen ovale saraf alveolar inferior melalui foramen mandibula pleksus gigi inferior saraf Mental melalui foramen mental.

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Compound Fraktur gigi bantalan bagian mandibula, ke d mulut melalui membran periodontal dan kadang-kadang melalui kulit di atasnya. Communited fraktur Biasanya senyawa ditandai dengan fragmentasi tulang Patologis Hasil dari mandibula sudah lemah oleh kondisi patologis.

Oikarinen dan Lindqvist mempelajari pasien dengan beberapa luka yang diderita di RTA. Fraktur wajah yang paling umum berada di rahang bawah. Penelitian telah menunjukkan bahwa insiden fraktur mandibula dipengaruhi oleh berbagai faktor etiologi misalnya lalu lintas Geografi tren Sosial Jalan peraturan perundang-undangan Seasons Oikarinen dan Malmstrom menganalisis fraktur mandibula.

Pada analisis hasil berikut diperoleh: Meskipun tubuh mandibula memiliki insiden tertinggi ketika spesiik ke fraktur mandibula, kondilus tetap situs yang paling umum untuk fraktur mandibula Penting Ekstra-oral Radiografi Oblique radiografi lateral kiri dan kanan Fraktur proksimal tubuh pdontogenik wilayah anjing Fraktur sudut, ramus dan daerah condylar Posterior-anterior tampilan Menunjukkan perpindahan patah tulang pada ramus, sudut, tubuh Diputar posterior-anterior tampilan Fraktur antara Simfisis dan daerah anjing Penting Intra-oral Radiografi periapikal radiografi: Asosiasi gigi ke garis fraktur patologi yang ada berhubungan dengan gigi dalam garis fraktur Fraktur gigi dalam garis fraktur mandibula oklusal radiografi: Asosiasi akar gigi ke garis fraktur Radiografi diinginkan Panoramic inefksi merupakan pemandangan keseluruhan tunggal mandibula terutama kondilus Standard tomography linear Computed tomography CT Tertutup pengurangan Imobilisasi Untuk memungkinkan penyembuhan tulang Melalui fiksasi garis fraktur 1.

Penyembuhan Tulang penyembuhan tulang primer: Tidak ada bentuk kalus fraktur Heals oleh proses 1. Renovasi Haversian langsung di situs yang patah tulang jika tidak ada gap ada Contact penyembuhanatau 2.

Cervical Vertigo

Deposisi tulang pipih jika ada celah kecil Gap penyembuhan Membutuhkan fiksasi kaku mutlak dengan kesenjangan minimal Tulang Healing Sekunder penyembuhan tulang: Penyembuhan Tulang penyembuhan tulang sekunder melibatkan pembentukan hematoma periosteal sub, jaringan granulasi, maka lapisan tipis bentuk tulang dengan pengerasan membran.

Tulang rawan hialin disimpan, apesifik oleh tulang tenun dan remodels menjadi tulang pipih dewasa Fraktur adalah senyawa ke dalam mulut melalui membran periodontal dibuka 2. Gigi mungkin rusak secara struktural atau kehilangan suplai darah sebagai akibat dari trauma sehingga pulpa kemudian menjadi nekrotik 3. Gigi dapat dipengaruhi oleh beberapa proses patologis yang sudah ada Indikasi untuk dihapus Absolute Relatif Indikasi mutlak fraktur longitudinal yang melibatkan akar Dislokasi atau subluksasi gigi dari soket Adanya infeksi periapikal garis fraktur Terinfeksi perikoronitis akut Indikasi Relatif gigi tak berfungsi yang akhirnya akan dihapus electively karies Ineksi Tingkat lanjut penyakit periodontal Gigi yang terlibat dalam fraktur diobati menyajikan lebih dari 3days setelah cedera