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Mandible Fracture Follow-up

  • Author: Thomas Widell, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Dec 01, 2014
 

Further Outpatient Care

Place patient on a diet of soft or pureed food.

Instruct patient to return if any signs of infection are noted.

If arch wires are in place, instruct patient on release of interwire bands and give proper tools. Inability to release bands can be fatal if the patient vomits or has an airway problem.

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Further Inpatient Care

Fractures of the mandible can be stable (favorable) or unstable (unfavorable) depending on how the fracture line courses in the bone. Muscles attached to the mandible continue to exert their forces. Elevators of the mandible are the masseter, temporalis, and medial pterygoid, while depressors and retractors are the mylohyoid, geniohyoid, and anterior belly of the digastric. Lateral pterygoid is the protrusor of the mandible.

Direction of fracture determines whether it is stable or unstable. Fractures running from posterior downward to anterior (favorable) generally are stable, because muscles pull the fragments together and can be treated with soft diet and arch wires if fragments are not aligned.

Fractures of the body of the mandible running from anterior to posterior in a downward direction (unfavorable) usually are displaced and can be stabilized with wire bar fixation of upper and lower teeth. Unstable fractures may require open reduction and internal fixation if they are not reduced by wire fixation or if they are markedly unstable.

An edentulous mandible usually is unfavorable, because the patient has no teeth to stabilize the fracture. A stable nondisplaced fracture in an edentulous patient may be splinted with his or her denture and the patient restricted to a diet of soft food. An unstable fracture usually requires internal fixation to maintain reduction.

All open fractures and unstable fractures require admission. Depending on institution, some patients with stable fractures that require arch band fixation are treated and released from ED, while others are treated on an inpatient basis.

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Inpatient & Outpatient Medications

Medications such as NSAIDs, acetaminophen, and a short course of narcotics can be used for pain control.

Liquid preparations of medications are preferable.

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Transfer

If appropriate specialists are not available in the receiving institution, arrange transfer to a higher-level hospital.

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Deterrence/Prevention

Use of seat belts and airbags can reduce incidence of facial injuries in motor vehicle crashes.

Use of helmet with facial guards can reduce injury in motorcycle accidents and accidents in such sports as skiing, snowboarding, hockey, and football.

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Complications

Complication include the following:

  • Loss of airway
  • Aspiration of avulsed teeth
  • Infection
  • Nonunion
  • Malnutrition and weight loss if teeth are banded together
  • Injury to inferior alveolar or, more distally, mental nerve
  • Posttraumatic stress disorder [12]
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Prognosis

Prognosis is generally favorable with proper treatment.

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Patient Education

Instruct patient on how to release Erich arch wire if he or she has problems with airway.

Place patient on a diet of soft or pureed food.

For patient education resources, see the Breaks, Fractures, and Dislocations Center and Teeth and Mouth Center, as well as Broken Jaw.

Patients should be informed of the high risk of posttraumatic stress disorder and be referred to a psychiatrist should symptoms occur.[12]

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Contributor Information and Disclosures
Author

Thomas Widell, MD Vice Chairman, Assistant Professor, Department of Emergency Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science; Associate Residency Director, University of Chicago Emergency Medicine Program; Program Director, Emergency Medical Education, Attending Physician, Mount Sinai Hospital Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, Council of Emergency Medicine Residency Directors, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Michelle Ervin, MD Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Hendler B. Maxillofacial trauma. Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book; 1998. 1093-1103.

  2. McGill J, Ling L, Taylor S. Facial trauma. Diagnostic Radiology in Emergency Medicine. Mosby-Year Book; 1992. 51-76.

  3. Smith R. Maxillofacial injuries. Harwood-Nuss A, ed. The Clinical Practice of Emergency Medicine. Lippincott, Williams & Wilkins Publishers; 1991. 337-43.

  4. Sullivan W. Trauma to the face. Wilson RF, Walt AJ, eds. Management of Trauma: Pitfalls and Practice. 2nd ed. Lippincott, Williams & Wilkins; 1996. 242-69.

  5. McKay MP. Facial trauma. Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, PA: Mosby Elsevier; 2006. Vol 1: 382-98/chap 39.

  6. Hasan N, Colucciello SA. Maxillofacial trauma. Tintinalli JE, Gabor KD, Stapczynski SJ, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw-Hill Co Inc; 2004. chap 257, p1583-1590.

  7. Snell R, Smith M. The face, scalp, and mouth. Clinical Anatomy for Emergency Medicine. Mosby-Year Book; 1993. 206-41.

  8. Cillo JE Jr, Ellis E 3rd. Management of bilateral mandibular angle fractures with combined rigid and nonrigid fixation. J Oral Maxillofac Surg. 2014 Jan. 72(1):106-11. [Medline].

  9. Gutta R, Tracy K, Johnson C, James LE, Krishnan DG, Marciani RD. Outcomes of mandible fracture treatment at an academic tertiary hospital: a 5-year analysis. J Oral Maxillofac Surg. 2014 Mar. 72(3):550-8. [Medline].

  10. Siwani R, Tombers NM, Rieck KL, Cofer SA. Comparative analysis of fracture characteristics of the developing mandible: the Mayo Clinic experience. Int J Pediatr Otorhinolaryngol. 2014 Jul. 78(7):1066-70. [Medline].

  11. Spoor T, Ramocki J, Kwito J. Ocular trauma. Wilson RF, Walt AJ, eds. Management of Trauma: Pitfalls and Practice. 2nd ed. Lippincott, Williams & Wilkins; 1996. 225-41.

  12. Glynn SM, Asarnow JR, Asarnow R, et al. The development of acute post-traumatic stress disorder after orofacial injury: a prospective study in a large urban hospital. J Oral Maxillofac Surg. 2003 Jul. 61(7):785-92. [Medline].

 
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Anatomy of the mandible.
 
 
 
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