Mandible Fractures: Consensus and Controversy

LEARNING OBJECTIVES: After studying this article and the associated videos, the participant should be able to: 1. Differentiate mandibular fractures that require operative management. 2. Accurately diagnose the anatomic location of a mandibular fracture. 3. List the benefits and weaknesses of multiple methods of maxillomandibular fixation. 4. Identify absolute indications to Arbeitsgemeinschaft für Osteosynthesefragen type (load bearing) fixation in mandible fractures. 5. Evaluate the risk-benefit profile of open management of condylar and subcondylar fractures. 6. Identify indications to remove a tooth at the site of a mandibular fracture. SUMMARY: Mandibular fractures are common injuries treated by plastic surgeons. There are several aspects of mandibular fracture care that are well studied and for which there is good consensus; however, there are areas of fracture care that elicit significant differences of opinion, even among experienced surgeons. The objectives of this continuing medical education article are to familiarize the reader with mandibular anatomy and the evaluation of and decision-making regarding patients with these fractures, and to explain in plain terms their operative management. In addition, the authors highlight particular areas of controversy in treatment to guide further research.