Mandibular Fracture

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Mandibular Fracture

  1. 1.  19yo Skateboarder presents after falling face first down staircase while trying to jump a railing. C/O pain opening mouth and numbness to lower lip.  T 98 HR 95 BP 150/80 RR 16 PO2 100%  HEENT: PEERLA, EOMI, ecchymosis under tongue, positive tongue blade test, decreased sensation to lower lip,diffuse swelling b/l to jaw, 1.5cm laceration to buccal mucosa on right
  2. 2. Star: Ramus Fx Triangle: Parasymphyseal fx Arrow: Linear Fx
  3. 3. Open Fracture Admit for IV Abx Clindamycin or Penicillin Barton Bandage for comfort Closed Reduction with wiring vs open reduction with internal fixation Closed Fracture OMFS c/s Usually outpatient management Reduction and Stability Barton Bandage for comfort
  4. 4. Common Location Condyle 36% Coronoid 2% Ramus 3% Angle 20% Body 21% Alveolar 3% Symphyseal 1% Parasymphyseal 14%  Imaging Options Panorex, Towne, Lateral, Oblique, CT  Check for intraoral lacerations=open fx  Multiple Mandible Fractures Common  Any fx near teeth=compound and needs abx
  5. 5. Tongue Blade Test  Screening test for Mandibular Fracture  Have patient bite tongue blade, rotate laterally  If fracture is present, pain will be so intense that patient will not be able to continue biting and the blade will NOT break  Test is 96% sensitive for mandibular fx, great way to avoid imaging in select patients
  6. 6. Panorex of Mandible Angle Fx Minimally displaced fx on CT
  7. 7.  http://img.tfd.com/MosbyMD/thumb/mandible.jpg  Chang, E. General Principles of Mandible Fracture and Occlusion. Medscape  www.urmc.rochester.edu/smd/rad/neurocases/Neurocase322.htm  Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter 257 Maxillofacial Trauma  Mettler. Essentials of Radiology. 2nd edition. Facial Fracture Chapter  Rhea, J. How to Simplify the CT diagnosis of LeFort Fractures.AJR, 2005.184: 1700-1705.  Alonso LL, Purcell TB. Accuracy of the tongue blade test in patients with suspected mandibular fracture. J Emerg Med. 1995 MayJun;13(3):297-304  https://www.acep.org/content.aspx?id=39806
  8. 8.  http://img.tfd.com/MosbyMD/thumb/mandible.jpg  Chang, E. General Principles of Mandible Fracture and Occlusion. Medscape  www.urmc.rochester.edu/smd/rad/neurocases/Neurocase322.htm  Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter 257 Maxillofacial Trauma  Mettler. Essentials of Radiology. 2nd edition. Facial Fracture Chapter  Rhea, J. How to Simplify the CT diagnosis of LeFort Fractures.AJR, 2005.184: 1700-1705.  Alonso LL, Purcell TB. Accuracy of the tongue blade test in patients with suspected mandibular fracture. J Emerg Med. 1995 MayJun;13(3):297-304  https://www.acep.org/content.aspx?id=39806

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