Mandible fracture

Revision as of 22:29, 16 July 2011 by Jswartz (talk | contribs)

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