Authors of section


Boaz Arzi

Executive Editor

Amy Kapatkin

General Editor

Frank Verstraete

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Parasymphyseal comminuted fracture

Parasymphyseal comminuted fractures

Comminuted fractures of the parasymphyseal region occur after falling from height, hit by car, blunt trauma, or a gunshot injury.


Introduction to mandibular fractures

Mandibular fractures can be classified into region of the mandible and severity of the fracture.

Mandible fracture classification

  1. Symphyseal separation
  2. Parasymphyseal
  3. Rostral
  4. Mandibular body
  5. Caudal mandible
  6. Ramus (including the coronoid process)
  7. Temporomandibular joint (mandibular head of the condylar process)


The mandible is complex because of the interaction of hard, soft tissues and teeth. The majority of the mandibular bone volume is occupied by teeth roots, blood vessels and nerves, making the application of internal fixation difficult.

The periodontal status of the teeth affects the bone quality of the mandible and should be considered when selecting the fracture fixation method.


In the mandible, form and function are interdependent. Minor anatomical malalignment affects the occlusion of the teeth and function.

Fracture comminution and soft tissue damage will affect the repair method chosen.


Imaging allows analysis of fracture patterns and assessment of the fracture complexity. Dental radiography combined with computed tomography (CT) and 3D reconstruction is ideal to assess fracture complexity and dental involvement.

Postoperative CT is recommended to assess the surgical results.


Cone beam CT technology for craniomaxillofacial surgery provides additional precision in 3D planning.

The soft tissue resolution is inferior to conventional CT.


3D printing of the skull provides for precise surgical planning.

The model can be used for:

  • Implant selection
  • Prebending of the plate
  • Practice surgery
  • Evaluation of surgical results

The diagnostic yield of plain skull radiographs is very limited compared to CT. It should only be used alone if CT is unavailable. Diagnostic imaging of the entire skull is recommended because mandibular fractures can be associated with other skull trauma.

MRI or ultrasound can be helpful for soft tissue injuries but are not included in the standard diagnostic work up.

Classification of parasymphyseal fractures

Fractures of the parasymphyseal region can be diagnosed via clinical examination and dental imaging.

They can be classified as simple or comminuted fractures.

Skeletal malocclusion is seen and loose, fractured or missing teeth may be observed.


Clinical signs of parasymphyseal comminuted fractures

Clinical signs of parasymphyseal fractures include:

  • Skeletal malocclusion
  • soft tissue trauma
  • Dysfunction and pain when eating
  • Pain on palpation