Mandibular Fractures

After nasal bone injury, mandibular fractures are the second most common facial fracture. Assaults and falls on the chin are responsible for most injuries. Because of its ring shape, fractures are often multiple. Most injuries are to the body, angle, and the condylar process. An impact to the point of the jaw may transmit forces through the condyles that can fracture the temporal bone and rupture the eardrum.

History and physical examination will detect nearly all injuries. Ask patients whether their teeth approximate normally and whether they have pain on jaw movement. Evaluate jaw opening and search for intraoral lacerations to determine whether the fracture is open or closed. Gingival lacerations may be hidden between the teeth. Ecchymosis under the tongue is a sensitive finding for mandibular fracture, and fracture-induced injury to the mandibular nerve produces anesthesia of the lower lip.

Patients with normal occlusion and a negative tongue-blade test rarely require imaging studies. Radiography may include panorex, Towne, and lateral oblique views. If the symphysis is involved, consider occulusal films if other views are normal. Sometimes plain films are normal despite a condylar fracture. If films are normal but clinical suspicion remains high, consider a CT scan of the condyles.

Patients with open fractures require admission and intravenous antibiotics. Penicillin G (2 to 4 million units IV) or clindamycin (600 to 900 IV) is considered the drug of choice, but clindamycin and first-generation cephalosporins are good alternatives. Patients may be made more comfortable with a Barton bandage, which is an Ace bandage wrapped around the jaw and head. This prevents excessive jaw movement. Many patients with closed fractures may be managed as outpatients after consultation with an oral surgeon.

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