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Mandibular Fracture
1.
2. 19yo Skateboarder
presents after falling face
first down staircase while
trying to jump a railing.
C/O pain opening mouth
and numbness to lower
lip.
T 98 HR 95 BP 150/80 RR
16 PO2 100%
HEENT: PEERLA, EOMI,
ecchymosis under tongue,
positive tongue blade test,
decreased sensation to
lower lip,diffuse swelling
b/l to jaw, 1.5cm laceration
to buccal mucosa on right
5. Open Fracture
Admit for IV Abx
Clindamycin or
Penicillin
Barton Bandage for
comfort
Closed Reduction
with wiring vs open
reduction with internal
fixation
Closed Fracture
OMFS c/s
Usually outpatient
management
Reduction and
Stability
Barton Bandage for
comfort
6. Common Location
Condyle 36%
Coronoid 2%
Ramus 3%
Angle 20%
Body 21%
Alveolar 3%
Symphyseal 1%
Parasymphyseal 14%
Imaging Options
Panorex, Towne, Lateral,
Oblique, CT
Check for intraoral
lacerations=open fx
Multiple Mandible
Fractures Common
Any fx near
teeth=compound and
needs abx
7. Tongue Blade Test
Screening test for Mandibular Fracture
Have patient bite tongue blade, rotate laterally
If fracture is present, pain will be so intense that patient
will not be able to continue biting and the blade will
NOT break
Test is 96% sensitive for mandibular fx, great way to
avoid imaging in select patients
9. http://img.tfd.com/MosbyMD/thumb/mandible.jpg
Chang, E. General Principles of Mandible Fracture and Occlusion.
Medscape
www.urmc.rochester.edu/smd/rad/neurocases/Neurocase322.htm
Tintanelli’s Emergency Medicine: A Comprehensive Study Guide.
Chapter 257 Maxillofacial Trauma
Mettler. Essentials of Radiology. 2nd edition. Facial Fracture Chapter
Rhea, J. How to Simplify the CT diagnosis of LeFort Fractures.AJR,
2005.184: 1700-1705.
Alonso LL, Purcell TB. Accuracy of the tongue blade test in patients
with suspected mandibular fracture. J Emerg Med. 1995 MayJun;13(3):297-304
https://www.acep.org/content.aspx?id=39806
10. http://img.tfd.com/MosbyMD/thumb/mandible.jpg
Chang, E. General Principles of Mandible Fracture and Occlusion.
Medscape
www.urmc.rochester.edu/smd/rad/neurocases/Neurocase322.htm
Tintanelli’s Emergency Medicine: A Comprehensive Study Guide.
Chapter 257 Maxillofacial Trauma
Mettler. Essentials of Radiology. 2nd edition. Facial Fracture Chapter
Rhea, J. How to Simplify the CT diagnosis of LeFort Fractures.AJR,
2005.184: 1700-1705.
Alonso LL, Purcell TB. Accuracy of the tongue blade test in patients
with suspected mandibular fracture. J Emerg Med. 1995 MayJun;13(3):297-304
https://www.acep.org/content.aspx?id=39806