Mandible fracture

Revision as of 06:37, 8 March 2014 by Rossdonaldson1 (talk | contribs) (Disposition)

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

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
  • 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 at outpatient in 2-3 days

See Also

Maxillofacial Trauma

Source

  • Tintinalli's