Mandible fracture

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

See Also

Maxillofacial Trauma

Source

• Tintinalli's