Signs and symptoms of mandibular fracture
- Pain in the jaw
- Feeling that teeth no longer align correctly
- Sensitivity of teeth to pressure
- Swelling, bruising, and deformity
- Difficulty opening the mouth
- Loose teeth
- Numbness in the chin and lower lip
- Trismus (difficulty opening the mouth)
- Step or space between teeth
- Bleeding from the gums
Diagnosis of mandibular fracture
- Plain film radiography (AP, lateral oblique, Townes views)
- Panoramic radiography for easier detection of fractures
- Computed tomography for the most accurate imaging
- Use of multiple views for difficult-to-identify condylar fractures
- 3D reconstruction for better visualization of fragment displacement
Classification of mandibular fracture
- Various classification systems of mandibular fractures are in use.
- The location of the fracture is an important classification criterion.
- Mandibular fractures can occur in different zones, including condylar, coronoid process, ramus, angle of mandible, body, parasymphysis, and symphysis.
- Alveolar fractures involve the alveolus of the mandible.
- Condylar fractures can be intracapsular or extracapsular and may involve dislocation or fractures of the neck of the condyle.
- Mandibular fractures can be classified based on the condition of the bone fragments and communication with the external environment.
- Greenstick fractures occur in children and are incomplete fractures of flexible bone.
- Simple fractures involve complete transection of the bone with minimal fragmentation.
- Comminuted fractures occur when the bone is shattered into fragments.
- Compound fractures communicate with the external environment, either through the skin or the oral cavity.
- The presence or absence of teeth affects the treatment of mandibular fractures.
Treatment and reduction techniques for mandibular fracture
- Consideration must be given to other illnesses that may jeopardize the patient before treating mandibular fractures.
- Immediate treatment is not always necessary, except in avulsive injuries or cases with airway compromise.
- A several-day delay in treatment does not significantly impact outcome or complication rates.
- Reduction and fixation of the fracture are important aspects of treatment.
- Avulsive type injuries and fractures with airway compromise may require immediate treatment.
- Reduction involves approximating the broken bone edges.
- Open reduction is done through an incision and physically manipulating the fracture into place.
- Closed reduction does not require an incision and relies on aligning the teeth to bring the fracture segments into place.
- Circumdental wiring is often used to align the teeth and bring the fracture segments together.
- Simple fractures are usually treated with closed reduction and indirect skeletal fixation (maxillo-mandibular fixation).
- Indirect skeletal fixation involves placing an arch bar secured to the teeth and securing the arch bars with wire loops.
- Closed reduction with direct skeletal fixation involves passing wires through the skin and around the jaw to secure the fracture segments.
- Open reduction with direct skeletal fixation allows direct manipulation of the fractured ends through an incision and can be secured with screws or plates.
- Treatment options for condylar fractures include closed reduction or open reduction and fixation.
- Closed reduction carries a risk of bone healing out of position, while open reduction risks temporary facial nerve damage and scarring.
- Paediatric condylar fractures are challenging due to growth potential and the risk of joint ankylosis.
- Edentulous mandible fractures require alternative fixation methods, such as skeletal fixation or open reduction and rigid internal fixation.
- High velocity injuries may result in severe soft tissue damage, requiring careful airway management and consideration of external fixation.
Complications, prognosis, and epidemiology of mandibular fracture
- Airway compromise can occur due to unstable fractures or soft tissue swelling.
- Bilateral mandible fractures can cause the tongue to fall back and block the airway.
- Fractures in tooth-bearing areas may result in alignment of the fracture segments when aligning the teeth.
- High velocity injuries can lead to vascular injury, particularly to the internal carotid and jugular.
- Loss of consciousness combined with aspiration of tooth fragments and blood can threaten the airway.
- Healing time for routine mandible fractures is 4-6 weeks.
- Patients who receive MMF take longer to regain mouth opening.
- Patients who receive RIF have higher infection rates.
- Long-term complications include loss of sensation in the mandibular nerve, malocclusion, and loss of teeth.
- The risk of fracture increases with more complicated fractures.
- Blunt force trauma is the leading cause of mandible fractures in North America.
- Motor vehicle collisions are a leading cause in India.
- High velocity injuries are more likely on battle grounds.
- Prior to safety measures, motor vehicle collisions were a leading cause of facial trauma.
- Unrestrained individuals in cars and unhelmeted motorcyclists have a higher risk of fracture.
- Management of mandible fractures has been mentioned as early as 1700 B.C.
- Open reduction was described as early as 1869.
- Modern techniques, including MMF and rigid internal fixation, have been described since the 1970s.
- Titanium-based rigid internal fixation became commonplace in the 1970s.
- Biodegradable plates and screws have been available since the 1980s.
- Condylar fractures have higher rates of malocclusion.
- Intracapsular fractures have a higher rate of late-term osteoarthritis.
- Pediatric condylar fractures have higher rates of ankylosis and growth disturbance.
- Mandibular fractures can lead to Freys syndrome.
- Displacement and dislocation increase the risk of malocclusion.
Mandibular fracture, also known as fracture of the jaw, is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums. Mandibular fractures occur most commonly among males in their 30s.
| Mandibular fracture | |
|---|---|
| Other names | Mandible fracture, fracture of the jaw |
 | |
| 3D computed tomographic image of a mandible fracture in two places. One is a displaced right angle fracture and the other is a left parasymphyseal fracture. | |
| Specialty | Oral & Maxillofacial Surgery |
| Symptoms | Decreased ability to open the mouth, teeth will not align properly, bleeding of the gums |
| Usual onset | Males in their 30s |
| Causes | Trauma, osteonecrosis, tumors |
| Diagnostic method | Plain X-ray, Panorex, CT scan |
| Treatment | Surgery within a few days |
Mandibular fractures are typically the result of trauma. This can include a fall onto the chin or a hit from the side. Rarely they may be due to osteonecrosis or tumors in the bone. The most common area of fracture is at the condyle (36%), body (21%), angle (20%) and symphysis (14%). Rarely the fracture may occur at the ramus (3%) or coronoid process (2%). While a diagnosis can occasionally be made with plain X-ray, modern CT scans are more accurate.
Immediate surgery is not necessarily required. Occasionally people may go home and follow up for surgery in the next few days. A number of surgical techniques may be used including maxillomandibular fixation and open reduction internal fixation (ORIF). People are often put on antibiotics such as penicillin for a brief period of time. The evidence to support this practice; however, is poor.
