Mandible fracture: Difference between revisions
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==Evaluation== | ==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 | *Test for inferior alveolar and mental nerve injury | ||
*Intraoral exam to rule-out: | *Intraoral exam to rule-out: | ||
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*Check Stenson's duct for bleeding | *Check Stenson's duct for bleeding | ||
==Workup== | ===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== | ==Management== | ||
*Barton's bandage | *Consider Barton's bandage | ||
**Ace wrap over top of head and underneath mandible | **Ace wrap over top of head and underneath mandible | ||
*Prophylactic antibiotics (treat all empirically as "open" fractures) | *Prophylactic antibiotics (treat all empirically as "open" fractures) | ||
**Penicillin G IV 2-4million units '''OR''' | **Penicillin G IV 2-4million units '''OR''' | ||
**[[Clindamycin]] 600 | **[[Clindamycin]] 600 QID (if penicillin-allergic) | ||
==Disposition<ref>Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.</ref>== | ==Disposition<ref>Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.</ref>== | ||
Revision as of 18:20, 19 March 2018
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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
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%
- If mandibular fracture present patient should reflexively open mouth (cannot break blade)
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:
- Airway compromise (e.g when lying flat)
- Unable to tolerate POs or secretions
- Inadequate pain control
- Otherwise may follow up 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.