Mandible fracture: Difference between revisions
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Revision as of 18:35, 11 June 2012
Background
- Always make sure that a unilateral fx is not in fact b/l
- Presume an open fx until intraoral examination shows otherwise
- Favorable vs unfavorable based on whether musculature reduces or opens the fx
Diagnosis
History
- Malocclusion
- Pain worsened by attempted movement
Exam
- Bite test
- Have pt bite on tongue blade and twist it
- If mandibular Fx present pt should reflexively open mouth (can't break blade)
- Sn 95%, Sp 65%
- If mandibular Fx present pt should reflexively open mouth (can't break blade)
- Have pt bite on tongue blade and twist it
- Test for inferior alveolar and mental nerve injury
- Intraoral exam to rule-out:
- Open fx
- Sublingual hematoma (suggestive of occult mandible fx)
- Dental or alveolar ridge fx
- Condyle injury test
- Place finger into external auditory canal and have pt open and close mouth
- Check Stenson's duct for bleeding
Management
- Imaging
- Panorex is initial imaging study of choice
- CT face or mandible if:
- Suspected condyle fx
- Complex fx
- Multiple facial fx
- Barton's bandage
- Ace wrap over top of head and underneath mandible
- Abx
- Penicillin G IV 2-4million units OR
- Clindamycin 600-900mg (if penicillin-allergic)
Disposition
- Closed fx > urgent oupt f/u
- Open fx > admission for operative repair
See Also
Source
- Tintinalli's