Mandible fracture
Revision as of 18:22, 13 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "can't" to "cannot")
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 fracture
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 (cannot break blade)
- Sn 95%, Sp 65%
- If mandibular fracture present patient should reflexively open mouth (cannot break blade)
- Have patient bite on tongue blade and twist it
- 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
- Imaging
- Panorex is initial imaging study of choice
- CT face or mandible if:
- Suspected condyle fracture
- Complex fracture
- Multiple facial fractures
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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Disposition[1]
Admit (ENT, OMFS, Plastics) for:
- Airway compromise (e.g when lying flat)
- Unable to tolerate POs or secretions
- Inadequate pain control
- Otherwise may followup as outpatient in 2-3 days
See Also
References
- ↑ Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.