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Clinical Summary

The alveolus is the tooth-bearing segment of the mandible and maxilla. Fracture of the alveolar process tends to occur most often in the thinner maxilla. The anterior alveolar processes are at greatest risk for fracture due to more direct exposure to trauma. Both subluxation and avulsion of teeth may be associated with underlying alveolar fractures. Various degrees of tooth mobility and gingival bleeding may occur.

Management and Disposition

Significant cosmetic deformity may result from alveolar bone loss; preservation of viable tissue is important. Gentle direct pressure over the alveolar segment with saline-soaked gauze, avulsed teeth preservation, tetanus prophylaxis, and appropriate antibiotic therapy covering oral flora are indicated. Given the degree of trauma involved, computed tomography (CT) imaging may be required to rule out further injuries. Oral surgery consultation should be obtained for possible wire stabilization or arch bar fixation.

FIGURE 6.13

Alveolar Ridge Fracture. Note the exposed alveolar bone segment and associated multiple teeth involvement. Attempts should be made to maximally preserve all viable tissue. (Photo contributor: Alan B. Storrow, MD.)

Pearls

  1. Always consider the possibility of an associated cervical spine injury when evaluating patients with facial trauma.

  2. Consider potential aspiration of avulsed teeth when teeth are missing.

  3. Alveolar ridge fractures may occur in edentulous patients.

FIGURE 6.14

Alveolar Ridge Fracture. This alveolar ridge fracture was caused by blunt trauma from a steering wheel in a frontal impact motor vehicle collision. (Photo contributor: R. Jason Thurman, MD.)

FIGURE 6.15

Alveolar Ridge Fracture. This open upper alveolar ridge fracture was caused by blunt force injury. (Photo contributor: Lawrence B. Stack, MD.)

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