Difference between revisions of "Mandible fracture"

(Created page with "==Diagnosis== -bite most sensitive (or tongue blade braking) -check Stenson's duct for bleeding -if suspicious: flat films (adult) --> panorex if neg CT with recontruct (ch...")
 
(DispositionTrauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.)
 
(37 intermediate revisions by 6 users not shown)
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==Diagnosis==
+
==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
  
-bite most sensitive (or tongue blade braking)
+
==Differential Diagnosis==
 +
{{Maxillofacial trauma DDX}}
  
-check Stenson's duct for bleeding
+
==Evaluation==
 +
[[File:NoDisManFracMark.png|thumb|Non-displaced fracture of the mandible on CT.]]
 +
[[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===
 +
*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 suspicious:
+
===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
  
flat films (adult) --> panorex if neg
+
===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
  
CT with recontruct (children)
+
==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==
 +
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)
 +
#Unable to tolerate POs or secretions
 +
#Inadequate pain control
 +
#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>
  
Sublingual hematoma is suggestive of an occult jaw fracture.
+
*Otherwise may follow up as outpatient in 2-3 days
 
 
 
 
 
Tongue blade test-havept bite down on tongue blade and twist it, if a mandibular Fx is present then the pt should reflexively openmouth...95% sensitive and 65% specific.
 
 
 
 
  
 
==See Also==
 
==See Also==
 +
*[[Maxillofacial Trauma]]
  
 +
==References==
 +
<references/>
  
Trauma: Maxilofacial
+
[[Category:ENT]]
 
+
[[Category:Orthopedics]]
 
 
 
 
 
 
 
[[Category:Trauma]]
 
[[Category:Trauma]]

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.