Repositioning and immobilization of mandibular fragments

At UKRMED Clinic in Kyiv, treatment of a lower-jaw fracture depends on more than the fracture line seen on an X-ray or CT scan. The surgeon also checks how the teeth meet, whether the jaw has shifted and how stable the broken segments are. Some fractures can be managed with temporary fixation; others require the bone to be repositioned and secured with plates and screws.

Sometimes the swelling looks worse than the fracture. In other cases, the face looks relatively normal but the bite feels completely wrong. The back teeth meet on one side and leave a gap on the other. The mouth opens, but the chin wanders slightly to the left. The lower lip may feel as if local anaesthetic has not quite worn off.

Those details are useful. At UKRMED in Kyiv, assessment of a mandibular fracture does not begin with choosing a fixation method. First, the surgeon needs to understand where the jaw has moved and whether its original position can be restored.

What happens when the fragments have shifted?

A broken mandible does not always separate into two obvious pieces. One segment may rotate only slightly. Another can be pulled upwards by the muscles attached near the angle of the jaw. On a scan, the difference may look small. Try closing the teeth, however, and it can feel anything but small.

Repositioning these fragments is called reduction. The bite provides one reference because the upper and lower teeth had their own established relationship before the injury. Jaw contour and imaging provide the rest of the information. A surgeon is therefore not trying to make two white lines on a scan look tidy. The real question is whether the jaw has returned to a position in which it can function normally.

The examination before treatment

The patient opens and closes the mouth first. Does the chin move straight? Which teeth make contact first? Is there a point where movement suddenly becomes painful? The doctor also feels along the mandible and checks the injured area for abnormal mobility. Sensation around the lower lip and chin is compared from side to side.

Why the lip? Inside the mandible runs the inferior alveolar nerve. A fracture passing near its canal can leave part of the lip or chin numb. That does not tell the whole story, but it is a useful clinical clue. Imaging then fills in the parts that cannot be judged through swelling and tooth contact alone.

An X-ray may be sufficient for a straightforward fracture. CT is more useful when several areas are involved, one fragment overlaps another or the direction of displacement is difficult to understand on a flat image.

How is the fracture kept stable?

There is no single fixation setup for every broken jaw. For a relatively stable fracture, the upper and lower jaws may be held together in the correct bite for a period of time. This is intermaxillary fixation. Depending on the case, the surgeon can use arch bars, elastics, wires or another system.

A more mobile fracture behaves differently. Consider a mandible broken near the front and again near the angle. The section between the two fracture lines can move almost independently. Trying to control it only through the teeth may not give enough stability. Open reduction allows the surgeon to reach the bone directly, place the fragments where they belong and secure them with small plates and screws.

The plates do not heal the fracture. They simply stop the reconstructed pieces from moving every time the patient speaks, swallows or begins to chew.

When does surgery become useful?

The difference is not simply “small fracture versus large fracture”. A narrow fracture line can still cause trouble if the bite has changed considerably. Meanwhile, another fracture may look dramatic on an image yet remain reasonably stable.

The decision is based on the combination: displacement, number of fracture sites, stability and the possibility of restoring the bite without direct surgical access. There is another detail that is easy to overlook — mandibular length.

If one side heals slightly shortened or rotated, the whole dental arch can be affected. A plate can be perfectly intact and the patient can still end up saying, “My teeth do not fit together the way they used to.” That is exactly what treatment is intended to avoid.

The first weeks after fixation

Food usually changes before anything else. Hard chewing is restricted, and with intermaxillary fixation the patient may need a liquid or very soft diet for a period of time. Cleaning around wires or arch bars also takes longer than ordinary brushing.

Swelling settles gradually. Jaw stiffness does too. What should not happen is a race back to normal chewing. The fracture needs enough stability before load is increased, but keeping the jaw unnecessarily inactive is not ideal either. Follow-up is used to find that balance.

A young patient with one uncomplicated fracture may progress quite differently from someone with several displaced fragments. General health, smoking, oral hygiene and the stability of fixation can also influence recovery. For that reason, the calendar is only a rough guide.

Mandibular fracture treatment at UKRMED

Not sure whether the jaw is actually broken after a fall or blow? The bite often gives a better clue than the amount of bruising. If the teeth suddenly meet differently, the mouth no longer opens normally, the lower lip has become numb or chewing causes sharp pain, a maxillofacial examination is reasonable.

At UKRMED in Kyiv, the surgeon assesses the bite, fracture position and imaging first, then decides whether temporary immobilization or internal fixation is more appropriate.