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Fracture of the Edentulous Mandible
FRACTURE OF THE EDENTULOUS MANDIBLE By W. I.
Jo
nes
, D.D.S.,
F.I.C.A., Columbus, Ohio
HE more any surgical procedure can be simplified, the fewer instru ments used and the less the manip ulation, the more likely is the operation to succeed. In confirmation of this statement, illustrations are shown of a method of using a trocar without a cannula for the circumferential wiring of a fractured mandible. Figure i shows the jaw before reduction of the fracture. The extreme
T
tached to the anterior portion of the bone. Barton or other head bandages, and plaster of Paris head caps with molded plaster or metal chin cups are practically useless in such cases, because they do not immobilize the jaw and only serve to in crease the deformity if there is any tend ency to displacement of the fragments. Likewise, the use of Lane plates or wire passing through the bone in such cases
Fig. i.-—Amount of displacement, the posterior fragment being pulled outward and upward by the masseter and temporal muscles and the anterior fragment being pulled downward and back by the hyoideus group of muscles. displacement of the fragments on the right side resulted in great deformity of the face. The patient received a blow from a bare fist on his toothless jaw, resulting in a double fracture of the mandible compounded to the mouth on the right side. There was extreme displacement of the fragments and much deformity owing to the outward and upward pull of the masseter muscle attached to the posterior fragment, and the inward and downward pull of the hyoid group of muscles atJour. A.D.A., Vol. 26, August 1939
is not satisfactory, for two reasons: ( i ) they do not immobilize the fragments sufficiently and (2) infection is more liable to occur around them than in cir cumferential wiring. This method of circumferential wiring, first advocated by G. V. Black, consists in passing a trocar and cannula through a small incision in the skin at the lower border of the mandible, keeping close to the bone on the lingual side until the mucous membrane is pierced. The tro car is removed and wire passed through
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Jones-—Fracture of the Edentulous Mandible
the cannula, and then the cannula is removed, the wire remaining in place on the lingual side of the bone. The same procedure is then carried out, that of passing a straight trocar, cannula and wire through on the labial side of the bone. (My method dispenses with the use of the cannula.)
and the ends are twisted together. The bones stay fixed in position, the wire is well tolerated and the skin and mucous membrane close without suppuration. After the bone is solidly united, a small incision is made in the mucous mem brane and the wire is cut and removed by grasping one end of the wire with a
Fig. 2.— Fracture reduced, and steel wire com pletely surrounding both fragments.
Fig. 3.— Method of employing eyeleted tro car.
It will be seen that the wire completely surrounds the bone, the ends of wire pro truding into the mouth. The bone fragments are then manipulated into position, and the wire is pulled tightly
pair of pliers. Figure 2 shows the po sition of fragments after wiring. Figure 3 illustrates the curved trocar with eyelet threaded with steel wire and the method of passing the wire through the incision in the skin and through the floor of the mouth. The trocar with eyelet simplifies the operation by obviating the use of a can nula. Its use means one less instrument to handle and consequently one less step in the procedure. A curved trocar should not be used to pass the wire on the labial or buccal surface of the mandible, but a straight one with an eyelet. Two trocars, a curved and a straight one, are necessary to perform this operation successfully, and the end of the trocar must be kept closely against the bone while passing through the tissues. 327 East State Street.
Jo
nes
, D.D.S.,
F.I.C.A., Columbus, Ohio
HE more any surgical procedure can be simplified, the fewer instru ments used and the less the manip ulation, the more likely is the operation to succeed. In confirmation of this statement, illustrations are shown of a method of using a trocar without a cannula for the circumferential wiring of a fractured mandible. Figure i shows the jaw before reduction of the fracture. The extreme
T
tached to the anterior portion of the bone. Barton or other head bandages, and plaster of Paris head caps with molded plaster or metal chin cups are practically useless in such cases, because they do not immobilize the jaw and only serve to in crease the deformity if there is any tend ency to displacement of the fragments. Likewise, the use of Lane plates or wire passing through the bone in such cases
Fig. i.-—Amount of displacement, the posterior fragment being pulled outward and upward by the masseter and temporal muscles and the anterior fragment being pulled downward and back by the hyoideus group of muscles. displacement of the fragments on the right side resulted in great deformity of the face. The patient received a blow from a bare fist on his toothless jaw, resulting in a double fracture of the mandible compounded to the mouth on the right side. There was extreme displacement of the fragments and much deformity owing to the outward and upward pull of the masseter muscle attached to the posterior fragment, and the inward and downward pull of the hyoid group of muscles atJour. A.D.A., Vol. 26, August 1939
is not satisfactory, for two reasons: ( i ) they do not immobilize the fragments sufficiently and (2) infection is more liable to occur around them than in cir cumferential wiring. This method of circumferential wiring, first advocated by G. V. Black, consists in passing a trocar and cannula through a small incision in the skin at the lower border of the mandible, keeping close to the bone on the lingual side until the mucous membrane is pierced. The tro car is removed and wire passed through
1360
1361
Jones-—Fracture of the Edentulous Mandible
the cannula, and then the cannula is removed, the wire remaining in place on the lingual side of the bone. The same procedure is then carried out, that of passing a straight trocar, cannula and wire through on the labial side of the bone. (My method dispenses with the use of the cannula.)
and the ends are twisted together. The bones stay fixed in position, the wire is well tolerated and the skin and mucous membrane close without suppuration. After the bone is solidly united, a small incision is made in the mucous mem brane and the wire is cut and removed by grasping one end of the wire with a
Fig. 2.— Fracture reduced, and steel wire com pletely surrounding both fragments.
Fig. 3.— Method of employing eyeleted tro car.
It will be seen that the wire completely surrounds the bone, the ends of wire pro truding into the mouth. The bone fragments are then manipulated into position, and the wire is pulled tightly
pair of pliers. Figure 2 shows the po sition of fragments after wiring. Figure 3 illustrates the curved trocar with eyelet threaded with steel wire and the method of passing the wire through the incision in the skin and through the floor of the mouth. The trocar with eyelet simplifies the operation by obviating the use of a can nula. Its use means one less instrument to handle and consequently one less step in the procedure. A curved trocar should not be used to pass the wire on the labial or buccal surface of the mandible, but a straight one with an eyelet. Two trocars, a curved and a straight one, are necessary to perform this operation successfully, and the end of the trocar must be kept closely against the bone while passing through the tissues. 327 East State Street.