Mandible Fracture in Emergency Medicine Workup

  • Author: Thomas Widell, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 30, 2011
 

Laboratory Studies

  • Direct laboratory studies toward workup of a trauma patient. If this is an isolated injury, laboratory studies may not be required.
  • If fracture is an isolated injury, obtain preoperative labs if surgery is planned.
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Imaging Studies

Radiographs

Best plain film to assess the mandible is a panorama view (ie, Panorex), which shows the mandible in its entirety in a single view. Panoramic view is not always available, as it requires a special radiographic machine. If panorama view is not available or patient is unable to sit for film, obtain routine mandible films.

Routine views include bilateral lateral oblique projections to look at the angle, body, and to a lesser extent, symphysis, and Townes view to look at the condyles.

Submental view can be helpful in evaluating the symphysis.

Obtain chest films of patients with unaccounted missing teeth to rule out aspiration.

Cervical spine radiographs may be indicated with severe facial injuries or in patients with a consistent mechanism and neck pain.[2]

Computed tomography

In selected patients with nondiagnostic radiographs in whom mandibular fracture is suspected strongly, CT scan may be necessary to diagnose condylar fracture.

CT scans often are used to better evaluate fracture prior to surgical repair.

Consider CT scan of the brain to rule out intracranial injury.

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Contributor Information and Disclosures
Author

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

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

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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

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

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

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

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

  6. Hasan N, Colucciello SA. Maxillofacial trauma. In: 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. In: Clinical Anatomy for Emergency Medicine. Mosby-Year Book; 1993:206-41.

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

  9. 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. Jul 2003;61(7):785-92. [Medline].

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