Favorable and Unfavorable Fractures-Aspire Mds

ASPIRE MDS-ASPIRE MASTERY
Classification of Mandibular Angle

Fracture based on Direction and
Favorability for Treatment
Notes with Imaging
Dr.Bhaumik Joshi
ASPIRE MDS ASPIRE MASTERY 2
Classification of Mandibular Angle Fracture based on Direction and Favorability for Treatment
Applied Surgical Anatomy (Overview):

 The elevator group of muscles exert an upward, forward and
medial pull, while depressor group of muscles exert a
downward and backward pull in an intact mandible.
Figure 1 Masseter Muscle: Direction of Muscle pull is upwards and Forwards
Figure 2 Medial Pterygoid (Marked 3 in the image):

Direction of Muscle pull is Upwards, Forwards and Medial
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 Whenever there is a break in the continuity at the angle region,

then these two muscle groups loose the balance.
 The co-ordination is lost and both groups start having

independent action.
Classification of Angle Fracture According to the

Direction of Fracture and Favourability for Treatment:
 The direction of fracture line is important for resisting the
muscle pull.
 In angle fracture, posterior ramus fragment is the proximal

(lesser) fragment, while the body of the mandible bearing the
teeth becomes the distal (greater) fragment
 When the muscle pull resists the displacement of the

fragments, then the fracture line is considered as Favorable.
 If the muscle pull distracts the fragments away from each

other, resulting in displacement, then the fracture line is
considered as Unfavorable
Angle fractures are classified as:

 Horizontally favorable fracture.
 Horizontally unfavorable fracture
 Vertically favorable fracture.
 Vertically unfavorable fracture

Horizontally Favorable and Unfvorable

Factures of Angle of Mandible
Horizontal Favorability or Unfavorability of Angle Fracture is decided

by
1. Viewing from the horizontal plane
2. Oblique lateral view mandible/OPG radiograph
Horizontally Favorable Fracture:
 Fracture line passes from the alveolar margin, downward and

forward towards inferior border of mandible
 In such cases upward displacement of the posterior fragment is

prevented by physical obstruction caused by the body of the
mandible.
 Hence, such a fracture line is termed horizontally favorable

Examples:
Figure 3: OPG image showing a fracture line running downward and forward from alveolar margin, the distal segment
(Ramal) is obstructed by proximal segment (Body) from being displaced superiorly
Figure 4: Diagrammatic representation showing a fracture line running downward and forward from alveolar margin,
the distal segment (Ramal) is obstructed by proximal segment (Body) from being displaced superiorly

Horizontally Unfavorable Fracture:
 Fracture line passes from the alveolar margin, downward and

backward towards inferior border of mandible
 In such cases upward displacement of the posterior fragment

can’t be opposed by the body of the mandible.
 Hence, such a fracture line is termed horizontally unfavorable

Examples:
Figure 5: OPG image showing a fracture line running downward and backward from alveolar margin, the distal segment
(Ramal) is not obstructed by proximal segment (Body) and is being displaced superiorly(horizontally unfavorable)
Figure 6: 3DCT image showing a fracture line running downward and backwards from alveolar margin, the distal
segment (Ramal) is not obstructed by proximal segment (Body) and is being displaced superiorly(horizontally
unfavorable)

Vertically Favorable and Unfvorable

Factures of Angle of Mandible
Vertical Favorability or Unfavorability of Angle Fracture is decided by
1. Viewing from the vertical plane
2. Axial section of CT scan
Vertically Favorable Fracture:
 Fracture line passes from the outer or buccal plate obliquely

backward and lingually
 This fracture line will tend to resist the muscle pull in the
medial direction due to the spasm of medial Pterygoid and
Mylohoid.
 In such cases medial displacement of the posterior fragment is

prevented by physical obstruction caused by the body of the
mandible.

Examples:
Figure 7: 3DCT image showing a fracture line running from the outer or buccal plate obliquely backward and
lingually (vertically favorable)
Figure 8: CT Scan Axial showing a fracture line running from the outer or buccal plate obliquely backward and
lingually (vertically favorable)

Figure 9 Vertical view (SMV) showing an imaginary fracture line running from the outer or buccal plate
obliquely backward and lingually (vertically favorable)

Vertically Unfavorable Fracture:
 Fracture line passes from the outer or buccal plate obliquely

Forwards and lingually
 This fracture line will not be able to resist the muscle pull in the
medial direction due to the spasm of medial Pterygoid
 In such cases medial displacement of the posterior fragment

can’t be opposed by the body of the mandible.
 Hence, such a fracture line is termed vertically unfavorable

Examples:
Figure 10: 3DCT image showing a fracture line running from the outer or buccal plate obliquely forwards and
lingually (vertically unfavorable)
Figure 11: imaging representation sowing a fracture line running from the outer or buccal plate obliquely
forwards and lingually (vertically unfavorable)

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ASPIRE MDS-ASPIRE MASTERY

Classification of Mandibular Angle

Applied Surgical Anatomy (Overview):

Figure 1 Masseter Muscle: Direction of Muscle pull is upwards and Forwards

Figure 2 Medial Pterygoid (Marked 3 in the image):

Aspire MDS Aspire Mastery

 Whenever there is a break in the continuity at the angle region,

 The co-ordination is lost and both groups start having

Classification of Angle Fracture According to the

 In angle fracture, posterior ramus fragment is the proximal

 When the muscle pull resists the displacement of the

 If the muscle pull distracts the fragments away from each

Angle fractures are classified as:

 Horizontally unfavorable fracture

 Vertically favorable fracture.

 Vertically unfavorable fracture

Horizontally Favorable and Unfvorable

Horizontal Favorability or Unfavorability of Angle Fracture is decided

 Fracture line passes from the alveolar margin, downward and

 In such cases upward displacement of the posterior fragment is

 Hence, such a fracture line is termed horizontally favorable

Aspire MDS Aspire Mastery

Aspire MDS Aspire Mastery

Horizontally Unfavorable Fracture:

 Fracture line passes from the alveolar margin, downward and

 In such cases upward displacement of the posterior fragment

 Hence, such a fracture line is termed horizontally unfavorable

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Aspire MDS Aspire Mastery

Vertically Favorable and Unfvorable

Vertically Favorable Fracture:

 Fracture line passes from the outer or buccal plate obliquely

 In such cases medial displacement of the posterior fragment is

Aspire MDS Aspire Mastery

Aspire MDS Aspire Mastery

Aspire MDS Aspire Mastery

Vertically Unfavorable Fracture:

 Fracture line passes from the outer or buccal plate obliquely

 In such cases medial displacement of the posterior fragment

 Hence, such a fracture line is termed vertically unfavorable

Aspire MDS Aspire Mastery

Aspire MDS Aspire Mastery

 The most awaited ASPIRE MDS TEST series is here

The Test Series has started. REGISTER SOON!

Contact to Join Whatsapp Group: 7405642887, 8530450250

Like FB Page: Aspire MDS-Aspiring Mastery

Join FB Group: Aspire MDS-Aspire Mastery

Aspire MDS Aspire Mastery

Aspire MDS Aspire Mastery

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