Mandible fracture

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Background

  • Always make sure that a unilateral fracture is not in fact bilateral
  • Presume an open fracture until intraoral examination shows otherwise
  • Favorable vs unfavorable based on whether musculature reduces or opens the fracture

Clinical Features

  • Malocclusion
  • Pain worsened by attempted movement

Differential Diagnosis

Maxillofacial Trauma

Evaluation

Bite-Test

  • Have patient bite on tongue blade and twist it
    • If mandibular fracture present patient should reflexively open mouth (cannot break blade)
      • Sn 95%, Sp 65%

Exam for concomitant injuries

  • 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

If high-risk (e.g. positive bite-test)

  • Panorex is initial imaging study of choice (if available)
  • CT face or mandible if:
    • Suspected condyle fracture
    • Complex fracture
    • Multiple facial fractures

Management

  • Consider 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 QID (if penicillin-allergic)

Disposition[1]

Admit (ENT, OMFS, Plastics) for:

  1. Airway compromise (e.g when lying flat)
  2. Unable to tolerate POs or secretions
  3. Inadequate pain control
  • Otherwise may follow up as outpatient in 2-3 days

See Also

References

  1. Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.