Mandibular fractures

Question 1

Give the clinical signs and symptoms of a mandibular fracture

Answer 1

• Pain
• Swelling
• Lim mouth opening
• Occlusal derangement
• Numbness lower lip
• Loose or mobile teeth
• Bleeding
• AOB
• Facial asymmetry
• Deviation of mandible to opp side
• Sublingual haematoma if pt edentulous and bleeding into FOM

Question 2

Give the 7 classifications of mandibular fractures

Answer 2

1. Involvement of surrounding tissue
   - Simple (surrounding ST intact but fracture of bone)
   - Compound (Bone fracture with ST involvement e.g. laceration)
   - Comminuted (Bone broken into mul small pieces e.g. bullet wound)
2. Number of fractures
   - Single
   - Double
   - Multiple
3. Site of fracture
   - Unilateral
   - Bilateral
4. Site of fracture
   - Angle of mandible
   - Subcondylar
   - Parasymphseal
   - Body
   - Ramus
   - Coronoid process
   - Condylar fracture (intra-extra capsular)
   - Alveolar process
5. Direction of fracture line (relates to displacement)
   - Favourable (if direction of fracture line minimise displacement)
   - Unfavourable (direction of fracture line does not minimise displacent)
6. Specific fractures
   - Green stick (not complete separation and mostly seen in children due to high organic content in bone)
   - Pathological fracture (due to lesion)
7. Displacement of fracture
   - Displaced
   - Undisplaced

Question 3

What factors cause displacement of mandibular fractures ?

Answer 3

• Direction of fracture line
• Opposing occlusion
• Magnitude of force
• Mechanism of injury
• Intact with ST (displacement unlikely if ST intact)
• Other ass fractures

Question 4

Management of Mandibular fractures

Answer 4

ABCD firstly
- Airway plus c-spine control
- Breathing
- Circulation plus haemorrhage control
- Disability are they head injured

Take full history including story of the trauma
- Blunt vs sharp
- when
- Other injuries
- Drugs/alcholol/smokign
- PMH
- Allergies
- SH

Take radiographs if necessary
- 2 views mandatory so take
OPT and PA mandible
2 PA zygoma or orbit
CBCT midface/NOE/Orbit

Analgesia
AB if grossly contam
Call on call OMFS and explain all the details and send the pt to the department with a letter detailing it all and the consulation you had with the OMFS consulatant