SUBMANDIBULAR APPROACH PPT for mandibular fractures.pptx

submandibular approach for mandibular fractures

1. SUBMANDIBULAR APPROACH Presented by – Dr. Ashish ( R1 )

2. INDICATIONS This approach is selected for fractures of the mandibular body and angle regions unsuitable for intraoral treatment . This applies to more difficult fracture patterns such as comminuted, atrophic, and defect fractures to allow optimal manipulation of the fragments, good control of the lingual cortex and inferior border

3. Exposure offered by the submandibular approach.

4. LAYERS IN SUBMANDIBULAR REGION

5. VITAL STRUCTURES

6. SKIN INCISION The incision can either be parallel to the inferior border of the mandible (A ) or be placed in an existing skin crease (B) for maximum cosmetic benefit (RSTL)

7. If using skin creases for the incision the orientation of the scalpel blade is parallel to the relaxed skin tension lines (RSTL).

8. SKIN INCISION   Skin incision is placed 2-3 cm below the inferior border of the mandible . Incision of skin and subcutaneous tissues exposes the underlying platysma muscle.

9. BLUNT DISSECTION OF PLATYSMA In order to protect the marginal mandibular branch of the facial nerve, the platysma is undermined bluntly with scissors prior to dividing it with a scalpel . The platysma muscle is divided sharply , preferably 2-3 cm below the mandibular border, not necessarily at the same level of the skin incision

10. EXPOSURE AND SPLITTING OF PTERYGOMASSETRIC SLING Superior subplatysmal dissection would expose the underlying marginal mandibular branch of the facial nerve (CN VII ) Divide the pterygomasseteric sling and incise the periosteum at the inferior border to expose the ramus.

11. FIXATION OF FRACTURE SEGMENTS

12. WOUND CLOSURE During wound closure, the pterygomasseteric sling is repaired . The wound is then closed in layers to realign the anatomic structures and eliminate dead space. The platysma muscle is repaired

13. The wound is then closed in layers to realign the anatomic structures and eliminate dead space. The platysma muscle is repaired

14. THANK YOU