If you’ve been involved in an accident or are a victim of assault your treatment plan may consist of setting broken bones back into position using titanium plates and screws. In some instances implants for the skull or eye sockets will also be necessary. The majority can be fitted ‘of the shelf’ but occasionally a custom made implant is required particular if large ares of bone have been lost. In these instances we use 3D planning and models to manufacture an implant design specifically to fit you.
Your lower jaw has been broken
We will have already established the number of fractures, where they have occurred and whether they need treatment during my examination of you.
The treatment that is about to take place involves a general anaesthetic, i.e. you are going to be put to sleep completely.
Outline of The Surgical Procedure
- The fractures are exposed through cuts in the mouth.
- The bones are put back into the best positions and held together with plates and screws.
- Your teeth may held together with elastics after the operation to help with healing of the bones.
What are the possible problems?
- Infection is uncommon because of the antibiotics that are used.
- Bleeding from the cuts inside your mouth is unlikely to be a problem but should the area bleed when you get home this can usually be stopped by applying pressure over the site for at least 10 minutes with a rolled up handkerchief or swab.
- There is a nerve that runs through the centre of the lower jaw that supplies feeling to your lower lip, chin and bottom teeth. This nerve may have been bruised at the time of the fracture and as a result you might already feel some tingling or numbness in your lip and / or chin. This tingling may also be caused or made worse by surgery. In the majority of people the numbness gets better on its own although it can take several months to do so.
- Occasionally teeth adjacent to the fracture site may be damaged by screws that are used.
- If it has been necessary to put any plates or screws in your jaw to hold it in position these are not normally removed unless they get infected because they tend not to cause problems. The metal that is used is titanium which does not set off metal detectors in airports etc.
What can I expect after the operation?
It is likely to be sore and regular painkillers will be arranged for you.
The discomfort is usually worse for the first few days although it may take a couple of weeks to completely disappear. It is also necessary to make sure that the fractures heal without any infection and so you will also be given antibiotics through a vein in your arm whilst you are in hospital. You will be sent home with painkillers and a course of antibiotics.
You usually stay in hospital for one night following the surgery. The following day the position of your fractures will be checked with X-rays before you are allowed home.
Although the plates and screws hold the fractures in place it still takes around six weeks for your lower jaw to heal completely. During this time you need to eat a relatively soft diet, the nature of which will be discussed with you by the doctors, nurses and dietitians.
It is also important that you keep your mouth as clean as possible for the first few weeks after surgery to prevent infection. It may be difficult to clean your teeth around stitches because it is sore. It is best to keep the area free from food debris by gently rinsing your mouth with a mouthwash or warm salt water (dissolve a flat teaspoon of kitchen salt in a cup of warm water) commencing on the day after surgery. If any wires, metal braces or screws are used to help guide your bite into the correct position they will be removed in the outpatient department when I am happy that your fracture have healed.
What does the operation involve?
Once you are asleep the fracture sites will be opened up. This involves making a cut on the inside of your mouth through the gum.
The broken bones are then put back together and held in place with small metal plates and screws.
The gum is stitched back into place with dissolvable stitches that can take a fortnight or even longer to fall out.
During the same operation it is often necessary to place wires or metal braces around your teeth so that elastic bands can be attached to them and guide your bite into the correct position after surgery.
Screws inserted into the jawbone above the teeth are occasionally used instead of these wires or metal braces.
Any elastic bands are not usually attached until the day after your operation, ie: your jaws will be able to move freely when you wake up from surgery.
Will anything else be done while I am asleep?
Occasionally it is necessary to remove damaged or decayed teeth at the site of the fracture. In very difficult fractures it is sometimes necessary to make a cut on the outside of the mouth through the skin. If this is going to take place, the site and size of the cut will be discussed with you before you sign any consent form for your operation.
Do I need to take any time off work?
Depending on the nature of your work it may be necessary to take a fortnight or so off work and avoid strenuous exercise for this time. It is important to remember that you should not drive or operate machinery for 48 hours after your general anaesthetic.
Will I need further appointments?
A review appointment will be arranged before you leave hospital. It is usual to keep a close eye on you for several months following treatment to make sure that your jaw heals uneventfully.
This procedure is suitable for fractures of the…
- Dentoalveolar fractures.
- Fracture of the angle of the mandible.
- Parasymphaseal fractures.
- Fractures of the condyle.