Mandible fracture: Difference between revisions

Revision as of 22:29, 16 July 2011

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%
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

Source

Tintinalli's

Authors:

@@ Line 1: / Line 1: @@
+==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==
-*Bite test most sensitive (or tongue blade breaking)
+===History===
+*Malocclusion
+*Pain worsened by attempted movement
+===Exam===
+*Bite test
 **Have pt bite on tongue blade and twist it
-***If mandibular Fx present then pt should reflexively open mouth
+***If mandibular Fx present pt should reflexively open mouth (can't break blade)
 ****Sn 95%, Sp 65%
+*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
-*If suspicious:
+===Management===
-**Flat films (adult)> panorex if neg
+*Imaging
-*CT with recontruct (children)
+**Panorex is initial imaging study of choice
-*Sublingual hematoma is suggestive of an occult jaw fracture.
+**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==
 [[Maxillofacial Trauma]]
+==Source==
+*Tintinalli's
 [[Category:Trauma]]