Mandibular Fractures Workup

Updated: May 22, 2018
  • Author: Donald R Laub, Jr, MD, MS, FACS; Chief Editor: Deepak Narayan, MD, FRCS  more...
  • Print
Workup

Imaging Studies

See the list below:

  • The following types of radiographs are helpful in diagnosis of mandibular fractures:

    • Panoramic radiograph

      Mandibular fracture. Postoperative pantomogram. Mandibular fracture. Postoperative pantomogram.
      Mandibular fracture. Close-up view of postoperativ Mandibular fracture. Close-up view of postoperative pantomogram.
      Mandibular fracture. Postoperative pantomogram. Mandibular fracture. Postoperative pantomogram.
    • Lateral oblique radiographs

      Mandibular fracture. Lateral view. Mandibular fracture. Lateral view.
    • Posteroanterior (PA) mandibular view

      Mandibular fracture. Infection treated with incisi Mandibular fracture. Infection treated with incision and drainage and intravenous antibiotics. Hardware was removed and site debrided. Postoperative posteroanterior cephalometric view demonstrating reconstruction plate in place.
    • Reverse Towne view

    • Mandibular occlusal view

    • Periapical radiographs

    • Temporomandibular joint views including tomography

    • CT scan

      Axial CT scan demonstrating multiple fractures of Axial CT scan demonstrating multiple fractures of the mandible.
      Axial CT scan demonstrating severe displacement. Axial CT scan demonstrating severe displacement.
  • Initial screening of patients is most effective with a panoramic radiograph, since it shows the entire mandible including the condyles.

  • Standard mandibular series should consist of at least a panoramic radiograph, a PA view, and a reverse Towne view.

  • Since an accurate panoramic radiograph requires that the patient is able to stand upright and without any motion, achieving good quality films with severely traumatized patients may be difficult. Traditional lateral oblique views of the mandible can be used when obtaining a panoramic radiograph is not possible.

  • The reverse Towne view is the plain film of choice for excluding condylar and subcondylar fractures. Transcranial temporomandibular radiographs also may be helpful in detecting condylar fractures and anterior displacement of the condylar head. If visualization of the condylar head is difficult with plain films, obtain a CT scan. Although high cost and radiation exposure limit its use, CT scan is ideal for intracapsular and high neck condylar fractures.

  • Occlusal views are helpful for accurate assessment of symphyseal fractures.

  • Obtain periapical radiographs of the teeth on either side of a fracture to assess root fractures.

Next:

Diagnostic Procedures

See the list below:

  • For cases where the preinjury occlusion is difficult to determine, particularly in partially dentate and edentulous patients, the use of study models is very helpful. Model surgery on the study models can be performed and acrylic splints fabricated to the new arch form. [60] These splints may include a lingual, palatal, or labial splint that will be secured in place during surgery. The splints may be secured with the use of circummandibular wires for the mandible or with circumzygomatic or piriform wires for the maxilla. A maxillary splint also may be secured with palatal screws.

  • For fully edentulous patients, dentures can be secured to the maxilla and mandible and used for splints. [47] If dentures are not available, impressions are taken of the jaws, and acrylic baseplates are processed and used as dentures. These are known as Gunning splints. An arch bar also can be processed into the dentures, or holes can be placed into the flange of the denture for intermaxillary wires. Prosthetic incisor teeth can be removed for existing dentures, and space can be made in the acrylic to allow food intake.

Previous