Professional Documents
Culture Documents
Anatomi Mandibula
Muscles of Mastication
OUTER SURFACE
Muscles of Mastication
INNER SURFACE
Muscles of Mastication
4 muscles of mastication
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
Masseter
Divided into 3 heads
Superficial:
largest head
Arises anterior 2/3rds of the lower border of the
zygomatic arch
Wide insertion to angle, forwards along lower border and
upwards to lower part of ramus
Intermediate:
Deep:
Masseter
Intermediate and deep fuse and pass
vertically downwards to fuse with
ramus
Nerve and artery divide muscle
incompletely into 3 parts
Masseteric nerve (Br of anterior
division of V3) runs between deep
and intermediate
Br of superficial temporal and
transverse facial runs between
superficial and intermediate
Temporalis
Arises temporal fossa between
inferior temporal line and
infratemporal crest
Inserts at posterior border of the
coronoid process and ascending
ramus
Upper and anterior fibres elevate the
mandible
Posterior fibres (horizontal) retract
the mandible (only muscles that do
Medial pterygoid
2 heads:
Deep:
Larger
Medial surface of the lateral pterygoid plate
and the fossa between 2 plates
Superficial :
Tuberosity of the maxilla and pyramidal
process of palatine bones
Insert lower and posterior part of angle (with
masseter)
Action: upwards and forwards and medially
Lateral pterygoid
2 heads:
Superior:
Infratemporal fossa
Inferior:
Lateral surface of the lateral pterygoid
Temporomandibular Joint
Articulation
Synovial joint between the condyle of
the mandible and the mandibular
fossa in the squamous part of the
temporal bone
Both bone surfaces covered with
layer of fibrocartilage identical to the
disc
No hyaline cartilage, therefore an
atypical joint
Temporomandibular Joint
Unique feature of the TMJs is the
articular disc.
Composed of fibrocartilaganeous tissue
Temporomandibular Joint
Inferior compartment
Allows for pure rotation of the
condylar head,
corresponds to the first 20 mm or so
of the opening of the mouth.
(opening and closing movements)
Superior compartment
involved in translational
movements
sliding the lower jaw forward or side
to side
Temporomandibular Joint
Temporomandibular Joint
TMJ Ligaments
3 ligaments associated with the TMJ:
1) Temporomandibular ligament (Major)
is really the thickened lateral portion
of the capsule, and it has two parts:
an outer oblique portion (OOP) and
an inner horizontal portion (IHP)
Lower border of zygomatic arch to posterior
border of the neck and ramus
TMJ Ligaments
2) stylomandibular ligament (minor)
separates the infratemporal region from
the parotid region
runs from the styloid process to the
angle of the mandible
3) Sphenomandibular ligament
(minor)
runs from the spine of sphenoid to the
lingula of the mandible
TMJ Ligaments
The minor ligaments are important in
that they define the limits of
movements,
ie the farthest extent of movements of
the mandible.
Not connected to joint
TMJ Ligaments
TMJ Ligaments
Nerve Supply
Inferior alveolar nerve branch of
the mandibular division of Trigeminal
(V) nerve, enters the mandibular
foramen and runs forward in the
mandibular canal, supplying
sensation to the teeth.
At the mental foramen the nerve
divides into two terminal branches:
Incisive nerve: supplies the anterior
teeth
Diagnosis Fraktur
Mandibula
Anamnesis
Pemeriksaan Fisik
Pemeriksaan Penunjang
Anamnesis
Hupp et al:
Who
When
Where
How
Hupp JR, Ellis E, Tucker MR. Contemporary Oral and Maxillofacial Surgery. Ed. Ke-5. Mosby Elsevier. St. Louis. 2008.
Pemeriksaan Fisik
Deformitas
Luka terbuka
Konfigurasi gigi
Maloklusi
Gigi hilang / fraktur
Inspek
si
Palpas
i
Pemeriksaan Penunjang
X foto cranium AP/L
X-foto oclusal
Reduksi Tertutup
Reduksi Tertutup
Penanganan fraktur mandibula secara konservatif,
yaitu dengan melakukan reposisi tanpa operasi
langsung pada garis fraktur dan imobilisasi dengan
interdental wiring atau eksternal pin fixation
Indikasi untuk reduksi tertutup (closed reduction)
Favorable fracture : closed reduction
mengurangi resiko keadaan tidak sehat
Comminuted fracture
Kurangnya soft tissue yang menutupi tempat
fraktur
Fraktur pada anak-anak
Fraktur koronoid
Fraktur kondilus
Reduksi terbuka
Open reduction adalah tindakan operasi untuk melakukan koreksi
defromitas-maloklusi yang terjadi pada patah tulang rahang bawah
dengan melakukan fiksasi dengan interosseus wiring atau dengan mini
plat+skrup serta imobilisasi dengan menggunakan interdental wiring.
Indikasi untuk open reduction antara lain :
a. Unfavourable fraktur pada sudut mandibula.
b. Unfavourable fraktur pada symphisis atau korpus mandibula.
c. Displaced fraktur kondilus bilateral
d. Perawatan tertunda dari fragmen fraktur non-contacting displaced.
e. Malunions diperlukan osteotomi.
f. Fraktur mandibula dimana maksila lawannya edentulous
g. Fraktur edentulous mandibula dengan displacement yang hebat.
h. Kasus dimana closed reduction merupakan kontra indikasi.
2. Submandibula
a. Sering disebut Risdon
Approach.
b. Insisi dilakukan 2 cm di
bawah sudut mandibula pada
lipatan kulit.
c. Lebar insisi sekitar 4-5 cm
3. Retromandibular
a. Pertama kali diperkenalkan
oleh Hinds dan Girotti (1967)
b. Insisi dilakukan kurang lebih
0,5 cm dibawah lubang telinga
dan meluas ke arah inferior 3
3.5 cm di daerah batas posterior
mandibula yang dapat
memanjang ke bawah sudut
mandibula.
4. Preaurikular
a. Pendekatan ini paling baik
untuk membuka daerah TMJ.
b. Insisi dilakukan pada lipatan
preaerikular, kurang lebih
sepanjang 2,5-3,5 cm.
d. Perhatikan agar tidak
melakukan insisi ke arah
inferior, karena dapat melukai
saraf fasialis yang masuk ke
batas posterior glandula parotis.
ABSTRACT
Introduction
The aim of the treatment is to re- duce the displaced fracture and
restore proper occlusion and facial contour.
compromised airway,
speech difficulties,
selesai
TERIMAKASIH.