Mandibular Body Fractures Workup

  • Author: Jose E Barrera, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 23, 2012
 

Imaging Studies

  • CT scanning and plain radiography, including panoramic, lateral-oblique, posteroanterior, occlusal, and periapical views, may be helpful. However, the single most informative radiologic study used in mandibular fracture diagnosis is panoramic radiography.
  • Panorex provides the ability to view the entire mandible in one radiograph. However, it requires an upright patient, and it lacks fine detail in the TMJ, symphysis, and dental/alveolar process regions.
  • Plain radiography may be helpful.
    • The lateral-oblique view helps diagnose ramus, angle, or posterior body fractures. The condyle, bicuspid, and symphysis regions are often unclear.
    • Mandibular occlusal views demonstrate discrepancies in the medial and lateral position of body fractures.
    • Caldwell posteroanterior views demonstrate any medial or lateral displacement of ramus, angle, body, or symphysis fractures.
  • CT scanning also may be helpful in assessment of facial fractures.
    • CT scanning allows physicians to survey for facial fractures in other areas, including the frontal bone, naso-ethmoid-orbital complex, orbits, and the entire craniofacial horizontal and vertical buttress systems.
    • Reconstructions of the facial skeleton are often helpful in conceptualizing the injury.
    • CT scanning is also ideal for condylar fractures, which are difficult to visualize.
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Jose E Barrera, MD  Director of Facial Plastic and Craniofacial Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Wilford Hall Medical Center; Adjunct Assistant Professor, Stanford University School of Medicine and University of Texas School of Medicine at San Antonio

Jose E Barrera, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Academy of Sleep Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen G Batuello, MD  Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Hassan H Ramadan, MD, MSc  Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Rhinologic Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Stephen G Batuello, MD  Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

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  2. Dodson TB. Third molars may double the risk of an angle fracture of the mandible. Evid Based Dent. 2004;5(3):78. [Medline].

  3. Kuriakose MA, Fardy M, Sirikumara M, et al. A comparative review of 266 mandibular fractures with internal fixation using rigid (AO/ASIF) plates or mini-plates. Br J Oral Maxillofac Surg. Aug 1996;34(4):315-21. [Medline].

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  9. Barber HD, Woodbury SC, Silverstein KE. Mandibular fractures. In: Oral and Maxillofacial Trauma. Philadelphia, Pa: WB Saunders Co; 1991:473-526.

  10. Collins CP, Pirinjian-Leonard G, Tolas A, et al. A prospective randomized clinical trial comparing 2.0-mm locking plates to 2.0-mm standard plates in treatment of mandible fractures. J Oral Maxillofac Surg. Nov 2004;62(11):1392-5. [Medline].

  11. Gardner KE, Aragon SB. The mandibular fracture. In: ENT Secrets. Philadelphia, Pa: Hanley & Belfus; 1996:302-309.

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  13. Lazow SK. The mandible fracture: a treatment protocol. J Craniomaxillofac Trauma. Summer 1996;2(2):24-30. [Medline].

  14. Schilli W, Stoll P, Bahr W. Mandibular fractures. In: Manual of Internal Fixation. New York, NY: Springer-Verlag; 1990:65-80.

  15. Spiessel B. The stability principle. In: Internal Fixation of the Mandible: A Manual of AO/ASIF Principle. New York, NY: Springer-Verlag; 1989:30-45.

 
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A mandible body fracture with displacement. (A) Transverse fracture of the right mandible. (B) Fixation achieved using miniplates at the superior and inferior borders. (C) Postoperative radiograph demonstrating fixation.
Forces acting on the mandible and demonstration of the relationship between muscle pulls and fracture angulation. (A) Horizontally unfavorable. (B) Horizontally favorable. (C) Vertically unfavorable. (D) Vertically favorable.
(A) An oblique fracture of the body fixed with 1 lag screw, in combination with a compression plate at the inferior border and a dental splint for tension. (B) A fracture of the mandible body with a basal triangle. (C) Open reduction and adequate fixation using a miniplate at the superior border and a reconstruction plate at the inferior border. (D) Postoperative radiograph demonstrating fixation. An open hole in the reconstruction plate lies between the triangle and the corpus.
 
 
 
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