Mandibular fracture repair is a surgical procedure used to treat fractures of the lower jaw, primarily aiming to restore the structural integrity of the jawbone, occlusal function, and facial appearance. This treatment is commonly indicated for mandibular fractures resulting from trauma such as traffic accidents, falls, or violence. The surgical process typically involves precise localization of the fracture site, realignment of the bone segments, and stabilization using internal fixation devices (such as plates and screws) to promote bone healing.
The key to successful treatment is timely repair to prevent long-term complications such as malocclusion, chewing difficulties, or facial deformities. The surgeon will develop a personalized treatment plan based on the fracture location, severity, and the patient’s overall health. Postoperative recovery requires rehabilitation and regular follow-up to ensure proper bone healing.
Mandibular fracture repair mainly falls into two categories: "Open Reduction and Internal Fixation (ORIF)" and "Closed Treatment." Open surgery involves incisions in the jaw or oral mucosa to directly reposition the bones and fix them with metal plates and screws; closed treatment is suitable for minimally displaced fractures and involves external traction or bite blocks to facilitate natural healing.
The surgical mechanism comprises three stages: first, precise localization of the fracture line; second, realignment (reduction) of the bone segments; third, fixation with biocompatible materials (such as titanium alloys) to provide short-term stability. The fixation devices maintain the bone position until natural callus formation, which generally takes 6 to 12 weeks. Imaging examinations (such as CT scans) are used to confirm surgical accuracy.
This treatment is indicated for cases with severely displaced mandibular fractures causing malocclusion, airway obstruction, or nerve injury. Specific indications include:
Additionally, if fractures lead to tooth loss or alveolar bone damage, surgery can be performed simultaneously for repair. The surgeon will evaluate the patient’s age, fracture type (such as linear or comminuted fractures), and overall health to decide whether emergency or delayed surgery is appropriate.
The procedure is usually performed under general anesthesia. The surgeon will select the incision site based on the fracture location, such as intraoral mucosal incisions to reduce scarring. The steps include: locating the fracture line, removing hematoma and unstable bone fragments, using instruments to reposition the bones, and finally fixing with plates and screws. Closed treatment may involve external fixators or bite blocks.
Postoperatively, antibiotics are administered to prevent infection, along with pain relievers and anti-inflammatory medications as prescribed. Dietary restrictions initially involve liquid or semi-liquid foods, avoiding early exertion on the jaw. The fixation devices are typically retained permanently, but in cases of severe infection or rejection, removal may be necessary through secondary surgery.
The main benefits include:
Using titanium alloy fixation devices provides sufficient support and excellent tissue compatibility. Open surgery can immediately stabilize the bones and is suitable for complex fractures. Compared to non-surgical treatments, surgery significantly shortens healing time and improves functional recovery.
Potential risks include:
Serious complications may include permanent temporomandibular joint damage, recurrent fractures, or secondary surgeries due to fixation failure. Failure to follow postoperative care instructions can lead to delayed healing or malunion.
Contraindications include:
Preoperative assessment involves full-mouth X-rays or 3D CT scans to evaluate fracture patterns. Patients should stop taking anticoagulants (such as aspirin) at least one week before surgery and strictly follow oral hygiene instructions afterward to prevent infection.
Surgical treatment may interact with antibiotics, analgesics, or physical therapy. For example, long-term steroid use may delay healing, requiring medication adjustments. If dental injuries are present, treatment should be coordinated with dental care.
Postoperative physical therapy (such as temporomandibular joint exercises) should be initiated after initial healing to avoid overexertion. Patients undergoing radiation therapy should inform their doctor to adjust the timing of surgery accordingly.
Clinical studies show that surgical treatment has a success rate exceeding 90%, with over 85% achieving restored occlusal function. Imaging follow-up indicates that properly fixed fractures show early signs of healing within 3 to 6 weeks.
Long-term data demonstrate that patients who undergo surgery have significantly better outcomes in eating, speech, and aesthetic satisfaction compared to non-surgical groups. For complex fractures, 3D printing navigation technology can improve surgical accuracy to over 95%.
Non-surgical treatments include:
These methods are suitable for minimally displaced fractures or patients unable to tolerate anesthesia. However, non-surgical treatment may result in malocclusion after healing, so risk assessment is necessary before choosing this approach.
Initially, it is recommended to consume liquid or very soft foods such as milkshakes, puddings, or mashed potatoes, and use straws to reduce exertion on the jaw. Avoid hard foods that require chewing and ensure balanced nutrition to promote healing. After 3 to 6 weeks, gradually transition to soft foods following medical advice.
What should I do if I experience temporomandibular joint pain or discomfort after surgery?Postoperative TMJ pain may be a normal response. Use anti-inflammatory and analgesic medications as prescribed. If pain persists or is accompanied by difficulty opening the mouth, return for examination to rule out joint damage or fixation issues. Avoid excessive movements like wide yawning or laughing, and perform gentle joint exercises as guided by a physical therapist.
What precautions should be taken for daily cleaning of fixed devices (such as arch bars)?Clean the fixation devices daily with fluoride toothpaste and a soft-bristled toothbrush to prevent food debris accumulation and infection. Use interdental brushes to clean between teeth, avoiding the surgical wound area. If the device becomes loose or causes mucosal ulcers, report to the medical team for adjustment.
When can I fully regain normal occlusal function after mandibular fracture repair?Complete bone healing typically takes 6 to 8 weeks, but functional recovery varies. Initially, avoid chewing on the affected side. After three months, gradual reintroduction of light occlusion is possible, and most patients can approach normal function by six months. Regular X-ray follow-up is essential for assessment.
When will normal temporomandibular joint sounds reappear, and is treatment necessary?In the early postoperative period, joint crepitus may occur due to swelling or fixation devices, which is common. If accompanied by severe pain, limited mouth opening, or joint locking, seek immediate medical attention, as it may involve improper fixation or joint injury.
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