Mandible fracture: Difference between revisions
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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:<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 | ||
Revision as of 05:48, 10 May 2019
Background
- Always make sure that a unilateral fracture is not in fact bilateral
- Presume an open fracture until intraoral examination shows otherwise
- Favorable vs unfavorable based on whether musculature reduces or opens the fracture
Clinical Features
- Malocclusion
- Pain worsened by attempted movement
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
Bite-Test
- Have patient bite on tongue blade and twist it
- If mandibular fracture present patient should reflexively open mouth (cannot break blade)
- Sn 95%, Sp 65%
- If mandibular fracture present patient should reflexively open mouth (cannot break blade)
Exam for concomitant injuries
- Test for inferior alveolar and mental nerve injury
- Intraoral exam to rule-out:
- Sublingual hematoma (suggestive of occult mandible fracture)
- Dental or alveolar ridge fracture
- Condyle injury test
- Place finger into external auditory canal and have patient open and close mouth
- Check Stenson's duct for bleeding
Workup
If high-risk (e.g. positive bite-test)
- Panorex is initial imaging study of choice (if available)
- CT face or mandible if:
- Suspected condyle fracture
- Complex fracture
- Multiple facial fractures
Management
- Consider Barton's bandage
- Ace wrap over top of head and underneath mandible
- Prophylactic antibiotics (treat all empirically as "open" fractures)
- Penicillin G IV 2-4million units OR
- Clindamycin 600 QID (if penicillin-allergic)
Disposition
Admit (ENT, OMFS, Plastics) for:[1]
- Airway compromise (e.g when lying flat)
- Unable to tolerate POs or secretions
- Inadequate pain control
- Open and/or unstable fractures[2]
- Otherwise may follow up as outpatient in 2-3 days
See Also
References
- ↑ Trauma: A Comprehensive Emergency Medicine Approach,, eds. Erick Legome and Lee W. Shockley. Cambridge University Press 2011.
- ↑ Widell T et al. Mandible Fracture Treatment & Management. Oct 2016. https://emedicine.medscape.com/article/825663-treatment#d2.