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Maxillofacial Trauma to the Jaw: Etiology, Classification, and Treatment

Maxillofacial trauma involving the mandible and/or midface encompasses fractures, dislocations, soft-tissue lacerations, dental injuries, and nerve damage.

Common Mechanisms

  • Motor vehicle collisions (MVC) – ~50%
  • Interpersonal violence / assault
  • Falls (elderly, intoxicated)
  • Sports injuries
  • Industrial accidents

Mandibular Fracture Patterns

  • Condylar / subcondylar – Most common (30–40%); often bilateral.
  • Angle – 20–30%; weakened by third molar.
  • Body / parasymphysis – Tooth-bearing segments.
  • Symphysis – Midline.
  • Ramus / coronoid – Less common.

Clinical Signs

  • Malocclusion (key sign), pain, trismus, numbness (V3), intraoral laceration, step-off, ecchymosis (floor of mouth).

Management

  1. ABCs, cervical spine clearance.
  2. CT maxillofacial (1 mm cuts, 3D recon) – gold standard.
  3. Open reduction internal fixation (ORIF) – miniplates, lag screws, IMF (arch bars, MMF screws).
  4. Closed treatment (MMF alone) for nondisplaced, favorable fractures.
  5. Dental rehabilitation: splinting, endo, prosthodontics.

Complications

  • Malunion/nonunion, infection, TMJ ankylosis, inferior alveolar nerve deficit, dental injury.

Early specialist (OMFS, plastics, ENT) involvement optimizes functional and aesthetic outcomes.

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