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Case 5 - Displaced Mandible Fracture At the Angle

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You.

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Let's start by looking at this unfortunate

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soul on the 3D reconstructions.

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So this portion of the mandible pretty much is the synthesis

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here. And you can see the little mental nerve foramen on either side.

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This is the portion of the body of the mandible.

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And in this individual, as you can see,

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there is a fracture at the junction between the body

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of the mandible and the angle of the mandible,

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the angle being this portion right here.

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So this fracture is displaced, as you can see,

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in the AP dimension, as well as when we look at it

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from underneath, you can see the distal fracture fragment,

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or the superior fracture fragment is lateral to the

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medial fracture fragment. In this individual,

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who has lots and lots of fractures,

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you see this going across the maxilla and as

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well as across at the bridge of the nose,

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I mean at the base of the nose, actually did not show a fracture

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involving the other side of the mandible.

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So this is the exception to the rule that the mandible is a ring structure.

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It may be that because of the other fractures

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taking off the pressure of the ring,

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those fractures being across the maxilla,

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that this patient did not have bilateral fractures.

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On the axial scans,

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we can see that displacement laterally of

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the more superior fracture fragment.

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And we also see that the inferior alveolar canal,

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which is demonstrated here on the affected side and here on

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the left side, is involved with the fracture right through here.

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So it's likely that this patient's nerve that is

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innervating the distal portion of the mandible and the teeth

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here is going to lead to some decreased sensation.

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Important to note that the mandibular

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condyle and the neck is not fractured,

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therefore less risk of potential avascular necrosis.

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And we will also comment about the plane of the

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fracture with respect to the molar teeth.

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In this case,

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you can see that it's beyond the existing molar teeth.

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This patient has had some extraction of the wisdom teeth,

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if you will.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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