HEAD, EYE, EAR, NOSE, AND THROAT
EMERGENCIESMandible Fracture
■ Second most common maxillofacial fracture (after nasal fractures) (see
Figure 14.10)
■ More common in males than females
■ Most common fracture site: Condyle > body > symphysis
■ Often two or more sites are fractured.
■ Significant force is required to fracture the symphysis.SYMPTOMS/EXAM
■ Blunt trauma is most common mechanism (fall, MVC, assault).
■ Pain and swelling of jaw, asymmetry, step-off
■ Trismus, malocclusion, deformity, bleeding
■ Check mental nerve (lower incisors, lower lip, or chin anesthesia).
■ Sublingual or buccal ecchymosis (pathognomonic)
■ Blood in the auditory meatus may be seen with a condylar fracture.DIAGNOSIS
■ When a patient bites down on a tongue blade, you should be able to twist
the blade until it breaks. Inability to break the tongue blade because the
patient can’t hold it tight enough suggests fracture.
■ Plain X-rays or mandible series usually confirm diagnosis.
■ Panorex X-ray may be preferred by consultant (see Figure 14.11A).
■ Consider CXR to rule out aspiration of teeth.
■ Consider facial CT for evaluation of possible associated injuries.TREATMENT
■ Remember ABCs first!
■ Maintain C-spine precautions until assessed.3%3%36%2%20%
14% 21%FIGURE 14.10. Distribution of fractures to the mandible.(Reproduced, with permission, from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s
Principles of Surgery, 8th ed. McGraw-Hill, 2005:513.)In victims of MVCs, the
presence of a mandible
fracture should prompt
evaluation for an upper
cervical spine injury.If mandible deviates toward
the side with pain →fracture.
If mandible deviates away
from side with pain →
dislocation.