A 19-year-old male presented after falling face first down a staircase while trying to jump a railing. He reported pain when opening his mouth and numbness to his lower lip. Examination found swelling and bruising under the tongue, a positive tongue blade test, and decreased sensation to the lower lip. Imaging showed fractures of the mandible ramus and parasymphyseal region, as well as a linear fracture. The patient was admitted for IV antibiotics and a Barton bandage for comfort, with plans for closed reduction and wiring or possible open reduction and internal fixation.

2.  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

4. Star: Ramus Fx
Triangle: Parasymphyseal fx Arrow: Linear Fx

5. 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

6. 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

7. 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

8. Panorex of
Mandible Angle Fx
Minimally
displaced fx on
CT

9.  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

10.  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