Mandible fracture

Revision as of 03:26, 3 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "Fx" to "fracture")

Background

  • Always make sure that a unilateral fracture is not in fact b/l
  • Presume an open fracture 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 patient bite on tongue blade and twist it
      • If mandibular fracture present patient 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 patient 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)

Differential Diagnosis

Maxillofacial Trauma

Disposition[1]

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

References

  1. Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.