Difference between revisions of "Mandible fracture"

(DispositionTrauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.)
 
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==Evaluation==
 
==Evaluation==
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[[File:NoDisManFracMark.png|thumb|Non-displaced fracture of the mandible on CT.]]
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[[File:3D CT mandible fracture.jpg|thumb|3D CT reconstruction of mandible fracture, white arrow marks fracture, red arrow marks moderate displacement and open bite]]
 
===Bite-Test===
 
===Bite-Test===
 
*Have patient bite on tongue blade and twist it
 
*Have patient bite on tongue blade and twist it
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**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'''
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**[[Penicillin G]] IV 2-4million units '''OR'''
 
**[[Clindamycin]] 600 QID (if penicillin-allergic)
 
**[[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>==
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==Disposition==
Admit (ENT, OMFS, Plastics) for:
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Admit (ENT, OMFS, Plastics) for:<ref>Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.</ref>
 
#Airway compromise (e.g when lying flat)
 
#Airway compromise (e.g when lying flat)
 
#Unable to tolerate POs or secretions
 
#Unable to tolerate POs or secretions
 
#Inadequate pain control
 
#Inadequate pain control
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#Open and/or unstable fractures<ref>Widell T et al. Mandible Fracture Treatment & Management. Oct 2016. https://emedicine.medscape.com/article/825663-treatment#d2.</ref>
  
 
*Otherwise may follow up as outpatient in 2-3 days
 
*Otherwise may follow up as outpatient in 2-3 days

Latest revision as of 05:48, 10 May 2019

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

Non-displaced fracture of the mandible on CT.
3D CT reconstruction of mandible fracture, white arrow marks fracture, red arrow marks moderate displacement and open bite

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)

Disposition

Admit (ENT, OMFS, Plastics) for:[1]

  1. Airway compromise (e.g when lying flat)
  2. Unable to tolerate POs or secretions
  3. Inadequate pain control
  4. Open and/or unstable fractures[2]
  • 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.
  2. Widell T et al. Mandible Fracture Treatment & Management. Oct 2016. https://emedicine.medscape.com/article/825663-treatment#d2.