Mandible Fracture in Emergency Medicine Follow-up
- Author: Thomas Widell, MD; Chief Editor: Rick Kulkarni, MD more...
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.
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.
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.
Transfer
- If appropriate specialists are not available in the receiving institution, arrange transfer to a higher-level hospital.
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.
Complications
- 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[9]
Prognosis
- Prognosis is generally favorable with proper treatment.
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 excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center and Teeth and Mouth Center. Also, see eMedicine's patient education articles Broken Jaw.
- Patients should be informed of the high risk of posttraumatic stress disorder and be referred to a psychiatrist should symptoms occur.[9]
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