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:
  • 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

Workup

• Imaging
  • Panorex is initial imaging study of choice
  • CT face or mandible if:
    • Suspected condyle fx
    • Complex fx
    • Multiple facial fx

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)

Disposition

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 followup as outpatient in 2-3 days

See Also

Maxillofacial Trauma

Source

• Tintinalli's