During inspection, determine whether the jaw is deviated. Deviation results from either a condylar fracture or dislocation. The chin will point away from a dislocation and toward a fracture. While the patient opens and closes the mouth, look for malocclusion. With LeFort fractures, patients may be unable to close the mouth due to premature occlusion of the molars. Zygomatic fractures also prevent jaw closure if the bone fragment either presses against the masseter or impinges on the coronoid process of the mandible. Test for anesthesia of the lips and gingiva, usually due to a fracture-associated nerve injury.
An intraoral exam may reveal significant pathology. The exam should include manipulation of each tooth, a search for intraoral lacerations, and stress of the mandible. Essentially all fractures can be detected or excluded by both palpating and stressing the jaw. By placing a finger in the external ear canal while a patient opens and closes the mouth, one can palpate the mandibular condyle during jaw motion.
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