Mandible fracture: Difference between revisions
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*Always make sure that a unilateral fracture is not in fact b/l | *Always make sure that a unilateral fracture is not in fact b/l | ||
*Presume an open fracture until intraoral examination shows otherwise | *Presume an open fracture until intraoral examination shows otherwise | ||
*Favorable vs unfavorable based on whether musculature reduces or opens the | *Favorable vs unfavorable based on whether musculature reduces or opens the fracture | ||
==Diagnosis== | ==Diagnosis== | ||
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*Test for inferior alveolar and mental nerve injury | *Test for inferior alveolar and mental nerve injury | ||
*Intraoral exam to rule-out: | *Intraoral exam to rule-out: | ||
**Sublingual hematoma (suggestive of occult mandible | **Sublingual hematoma (suggestive of occult mandible fracture) | ||
**Dental or alveolar ridge | **Dental or alveolar ridge fracture | ||
*Condyle injury test | *Condyle injury test | ||
**Place finger into external auditory canal and have patient open and close mouth | **Place finger into external auditory canal and have patient open and close mouth | ||
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**Panorex is initial imaging study of choice | **Panorex is initial imaging study of choice | ||
**CT face or mandible if: | **CT face or mandible if: | ||
***Suspected condyle | ***Suspected condyle fracture | ||
***Complex | ***Complex fracture | ||
***Multiple facial | ***Multiple facial fracture | ||
==Management== | ==Management== |
Revision as of 00:50, 8 July 2016
Background
- Always make sure that a unilateral fracture is not in fact b/l
- Presume an open fracture until intraoral examination shows otherwise
- Favorable vs unfavorable based on whether musculature reduces or opens the fracture
Diagnosis
History
- Malocclusion
- Pain worsened by attempted movement
Exam
- Bite test
- Have patient bite on tongue blade and twist it
- If mandibular fracture present patient should reflexively open mouth (can't break blade)
- Sn 95%, Sp 65%
- If mandibular fracture present patient should reflexively open mouth (can't break blade)
- Have patient bite on tongue blade and twist it
- Test for inferior alveolar and mental nerve injury
- Intraoral exam to rule-out:
- Sublingual hematoma (suggestive of occult mandible fracture)
- Dental or alveolar ridge fracture
- Condyle injury test
- Place finger into external auditory canal and have patient open and close mouth
- Check Stenson's duct for bleeding
Workup
- Imaging
- Panorex is initial imaging study of choice
- CT face or mandible if:
- Suspected condyle fracture
- Complex fracture
- Multiple facial fracture
Management
- Barton's bandage
- Ace wrap over top of head and underneath mandible
- Prophylactic antibiotics (treat all empirically as "open" fractures)
- Penicillin G IV 2-4million units OR
- Clindamycin 600-900mg (if penicillin-allergic)
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Disposition[1]
Admit (ENT, OMFS, Plastics) for:
- Airway compromise (e.g when lying flat)
- Unable to tolerate POs or secretions
- Inadequate pain control
- Otherwise may followup as outpatient in 2-3 days
See Also
References
- ↑ Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.