Mandible fracture - Revision history

Rossdonaldson1 at 20:16, 2 December 2021

2021-12-02T20:16:40Z

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	[[File:Mandbular fractures.png\|thumb\|Mandibular fracture frequency by location<ref> Marius Pricop, Horațiu Urechescu, Adrian Sîrbu (Mar 2012). "Fracture of the mandibular coronoid process – case report and review of the literature". Revista de Chirurgie Oro-maxilo-facială și Implantologie (in Romanian). 3 (1): 1–4. ISSN 2069-3850. 58. Retrieved 2012-08-19.[permanent dead link]</ref>]]		[[File:Mandbular fractures.png\|thumb\|Mandibular fracture frequency by location<ref> Marius Pricop, Horațiu Urechescu, Adrian Sîrbu (Mar 2012). "Fracture of the mandibular coronoid process – case report and review of the literature". Revista de Chirurgie Oro-maxilo-facială și Implantologie (in Romanian). 3 (1): 1–4. ISSN 2069-3850. 58. Retrieved 2012-08-19.[permanent dead link]</ref>]]
	[[File:Gray176.png\|thumb\|Mandibular anatomy, lateral view.]]		[[File:Gray176.png\|thumb\|Mandibular anatomy, lateral view.]]
			[[File:Gray177.png\|thumb\|Mandibular anatomy, medial view.]]
	*Always make sure that a unilateral fracture is not in fact bilateral		*Always make sure that a unilateral fracture is not in fact bilateral
	*Presume an open fracture until intraoral examination shows otherwise		*Presume an open fracture until intraoral examination shows otherwise

Rossdonaldson1: /* Background */

2021-12-02T20:15:16Z

Background

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	==Background==		==Background==
	[[File:Mandbular fractures.png\|thumb\|Mandibular fracture frequency by location<ref> Marius Pricop, Horațiu Urechescu, Adrian Sîrbu (Mar 2012). "Fracture of the mandibular coronoid process – case report and review of the literature". Revista de Chirurgie Oro-maxilo-facială și Implantologie (in Romanian). 3 (1): 1–4. ISSN 2069-3850. 58. Retrieved 2012-08-19.[permanent dead link]</ref>		[[File:Mandbular fractures.png\|thumb\|Mandibular fracture frequency by location<ref> Marius Pricop, Horațiu Urechescu, Adrian Sîrbu (Mar 2012). "Fracture of the mandibular coronoid process – case report and review of the literature". Revista de Chirurgie Oro-maxilo-facială și Implantologie (in Romanian). 3 (1): 1–4. ISSN 2069-3850. 58. Retrieved 2012-08-19.[permanent dead link]</ref>]]
			[[File:Gray176.png\|thumb\|Mandibular anatomy, lateral view.]]
	*Always make sure that a unilateral fracture is not in fact bilateral		*Always make sure that a unilateral fracture is not in fact bilateral
	*Presume an open fracture until intraoral examination shows otherwise		*Presume an open fracture until intraoral examination shows otherwise

Rossdonaldson1: /* Background */

2021-12-02T20:13:31Z

Background

← Older revision		Revision as of 20:13, 2 December 2021
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	==Background==		==Background==
			[[File:Mandbular fractures.png\|thumb\|Mandibular fracture frequency by location<ref> Marius Pricop, Horațiu Urechescu, Adrian Sîrbu (Mar 2012). "Fracture of the mandibular coronoid process – case report and review of the literature". Revista de Chirurgie Oro-maxilo-facială și Implantologie (in Romanian). 3 (1): 1–4. ISSN 2069-3850. 58. Retrieved 2012-08-19.[permanent dead link]</ref>
	*Always make sure that a unilateral fracture is not in fact bilateral		*Always make sure that a unilateral fracture is not in fact bilateral
	*Presume an open fracture until intraoral examination shows otherwise		*Presume an open fracture until intraoral examination shows otherwise

Rossdonaldson1: /* DispositionTrauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011. */

2019-05-10T05:48:40Z

DispositionTrauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.

← Older revision		Revision as of 05:48, 10 May 2019
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	**[[Clindamycin]] 600 QID (if penicillin-allergic)		**[[Clindamycin]] 600 QID (if penicillin-allergic)

	==Disposition<ref>Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.</ref>==		==Disposition==
	~~Admit (ENT, OMFS, Plastics) for:~~		Admit (ENT, OMFS, Plastics) for:<ref>Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.</ref>
	#Airway compromise (e.g when lying flat)		#Airway compromise (e.g when lying flat)
	#Unable to tolerate POs or secretions		#Unable to tolerate POs or secretions

Rossdonaldson1: /* Management */

2019-05-10T05:48:01Z

Management

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	**Ace wrap over top of head and underneath mandible		**Ace wrap over top of head and underneath mandible
	*Prophylactic antibiotics (treat all empirically as "open" fractures)		*Prophylactic antibiotics (treat all empirically as "open" fractures)
	**Penicillin G IV 2-4million units '''OR'''		**[[Penicillin G]] IV 2-4million units '''OR'''
	**[[Clindamycin]] 600 QID (if penicillin-allergic)		**[[Clindamycin]] 600 QID (if penicillin-allergic)

Rossdonaldson1: /* DispositionTrauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011. */

2019-05-10T05:47:41Z

DispositionTrauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.

← Older revision		Revision as of 05:47, 10 May 2019
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	#Inadequate pain control		#Inadequate pain control
	#Open and/or unstable fractures<ref>Widell T et al. Mandible Fracture Treatment & Management. Oct 2016. https://emedicine.medscape.com/article/825663-treatment#d2.</ref>		#Open and/or unstable fractures<ref>Widell T et al. Mandible Fracture Treatment & Management. Oct 2016. https://emedicine.medscape.com/article/825663-treatment#d2.</ref>

	*Otherwise may follow up as outpatient in 2-3 days		*Otherwise may follow up as outpatient in 2-3 days

Rossdonaldson1: /* Evaluation */

2019-05-10T05:47:19Z

Evaluation

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	==Evaluation==		==Evaluation==
	[[File:NoDisManFracMark.png\|thumb\|Non-displaced fracture of the mandible on CT.]]		[[File:NoDisManFracMark.png\|thumb\|Non-displaced fracture of the mandible on CT.]]
			[[File:3D CT mandible fracture.jpg\|thumb\|3D CT reconstruction of mandible fracture, white arrow marks fracture, red arrow marks moderate displacement and open bite]]
	===Bite-Test===		===Bite-Test===
	*Have patient bite on tongue blade and twist it		*Have patient bite on tongue blade and twist it

Rossdonaldson1: /* Evaluation */

2019-05-10T05:45:49Z

Evaluation

← Older revision		Revision as of 05:45, 10 May 2019
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	==Evaluation==		==Evaluation==
			[[File:NoDisManFracMark.png\|thumb\|Non-displaced fracture of the mandible on CT.]]
	===Bite-Test===		===Bite-Test===
	*Have patient bite on tongue blade and twist it		*Have patient bite on tongue blade and twist it

Kxl328: /* DispositionTrauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011. */

2018-11-01T03:22:41Z

DispositionTrauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.

← Older revision		Revision as of 03:22, 1 November 2018
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	#Unable to tolerate POs or secretions		#Unable to tolerate POs or secretions
	#Inadequate pain control		#Inadequate pain control
			#Open and/or unstable fractures<ref>Widell T et al. Mandible Fracture Treatment & Management. Oct 2016. https://emedicine.medscape.com/article/825663-treatment#d2.</ref>
	*Otherwise may follow up as outpatient in 2-3 days		*Otherwise may follow up as outpatient in 2-3 days

Rossdonaldson1 at 18:20, 19 March 2018

2018-03-19T18:20:22Z

← Older revision		Revision as of 18:20, 19 March 2018
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	==Evaluation==		==Evaluation==
	===~~Exam~~===		===Bite-Test===
	*Bite test		*Have patient bite on tongue blade and twist it
	**Have patient bite on tongue blade and twist it		**If mandibular fracture present patient should reflexively open mouth (cannot break blade)
	***If mandibular fracture present patient should reflexively open mouth (cannot break blade)		***Sn 95%, Sp 65%
	****Sn 95%, Sp 65%
			===Exam for concomitant injuries===
	*Test for inferior alveolar and mental nerve injury		*Test for inferior alveolar and mental nerve injury
	*Intraoral exam to rule-out:		*Intraoral exam to rule-out:
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	*Check Stenson's duct for bleeding		*Check Stenson's duct for bleeding

	==Workup==		===Workup===
	*Imaging		''If high-risk (e.g. positive bite-test)''
	**Panorex is initial imaging study of choice		*Panorex is initial imaging study of choice (if available)
	**CT face or mandible if:		*CT face or mandible if:
	***Suspected condyle fracture		**Suspected condyle fracture
	***Complex fracture		**Complex fracture
	***Multiple facial fractures		**Multiple facial fractures

	==Management==		==Management==
	*Barton's bandage		*Consider Barton's bandage
	**Ace wrap over top of head and underneath mandible		**Ace wrap over top of head and underneath mandible
	*Prophylactic antibiotics (treat all empirically as "open" fractures)		*Prophylactic antibiotics (treat all empirically as "open" fractures)
	**Penicillin G IV 2-4million units '''OR'''		**Penicillin G IV 2-4million units '''OR'''
	**[[Clindamycin]] 600~~-900mg~~ (if penicillin-allergic)		**[[Clindamycin]] 600 QID (if penicillin-allergic)

	==Disposition<ref>Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.</ref>==		==Disposition<ref>Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.</ref>==