Fractures of the mandibular bone, or the lower jaw, are considered as the most common types of maxillofacial fracture encountered in clinical practice [1]. It is much more frequently encountered in males, with an established male-to-female ratio between 3:1 across various reports [2] [3]. In the majority of cases, patients likely suffer from jaw fractures after road traffic accidents, falls, during sports activities or intentionally inflicted injuries (domestic violence, assaults, and child abuse are notable examples) [3], but low-velocity blunt force injuries are described as the predominant mechanism of fracture [4]. Specifically, sports-related injuries are most commonly encountered in younger individuals (boxing and other contact sports), whereas falls (usually on the face) are the main cause of fracture in the elderly population [3]. Fractures of the mandible may occur at the angle, the mandibular symphysis, condyle, and sub condyle, whereas the body may also be a site of the fracture. Common symptoms are the pain, numbness, malocclusion due to the trauma of the teeth that may be displaced or missing, impaired occlusion, bleeding, and limited opening of the mouth due to temporomandibular joint instability and consequent trismus [5]. Preauricular pain is a specific sign of a condylar fracture and unilateral injury to this part of the bone results in deviation of the jaw [5]. Mental nerve paresthesias may be encountered as well [3]. Due to its anatomical characteristics, the mandible is often fractured on more than one site, illustrating the importance of a thorough workup and a detailed assessment. In the setting of more severe trauma, respiratory difficulties, including dyspnea and crepitus, may be observed.

• Jaw Pain

  And unfortunately, any form of jaw pain can inhibit these pivotal functions. Chronic jaw pain results from a variety of conditions: teeth-grinding, TMJ, periodontal disease and even certain sinus issues. [colgate.com]

  Invariably, these patients are awakened with jaw pain as the jaw shifts into unfavourable positions that generate micromovement in minimally displaced fractures. [ncbi.nlm.nih.gov]

  You have jaw pain that does not go away with medicine. The wires in your mouth are loose. You have questions or concerns about your condition or care. Care Agreement You have the right to help plan your care. [drugs.com]

  Signs & Symptoms of Mandibular Fracture or Broken Jaw Jaw pain is the commonest symptom experienced in mandibular fracture or broken jaw. There is swelling on the jaw. [epainassist.com]

• Meningism

  The most frequently reported complications of surgery are temporary or permanent loss of sensation in the face, loss of smell and/or taste, meningitis, sinus infection, infection in the bones (osteomyelitis), damage to the teeth, malocclusion, scars and [aspetar.com]

A thorough patient history is the first step in the diagnostic workup of mandibular fractures, in order to assess the mode of injury and determine the presence of other accompanying fractures, for eg. those of the cervical spine, as well as airway damage that may require immediate care [6]. A detailed and complete examination of the head and neck should follow, during which the physician must exclude other accompanying injuries and make the initial diagnosis. Inspection and palpation of the mandible, together with an assessment of teeth for possible injury and jaw mobility can confirm mandibular and other associated fractures, while confirmation can be obtained through imaging studies. Panoramic radiography is considered to be a good initial method for isolated mandibular fractures [5] and is even considered as a superior method to more advanced imaging studies, such as computed tomography (CT) [6]. However, a helical CT scanning has shown to be of significant benefit when evaluating patients for maxillofacial fractures, especially when radiography is not conclusive, and should be performed when possible [5] [6]. Although magnetic resonance imaging is an even more sophisticated method compared to CT and radiography, its use is restricted to assessment of soft tissues in the setting of maxillofacial injuries, and rarely in the examination of bony structures.

1. Boffano P, Roccia F, Zavattero E, Dediol E, Uglešić V, Kovačič Ž, et al. European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study. J Craniomaxillofac Surg. 2015;43(1):62-70.
2. Gutta R, Tracy K, Johnson C, James LE, Krishnan DG, Marciani RD. Outcomes of mandible fracture treatment at an academic tertiary hospital: a 5-year analysis. J Oral Maxillofac Surg. 2014;72(3):550-558.
3. Yildirgan K, Zahir E, Sharafi S, et al. Mandibular Fractures Admitted to the Emergency Department: Data Analysis from a Swiss Level One Trauma Centre. Emergency Med Int. 2016;2016:3502902.
4. Morris C, Bebeau NP, Brockhoff H, Tandon R, Tiwana P. Mandibular fractures: an analysis of the epidemiology and patterns of injury in 4,143 fractures. J Oral Maxillofac Surg. 2015;73(5):951.e1-951.e12
5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
6. Perez R, Oeltjen JC, Thaller SR. A Review of Mandibular Angle Fractures. Craniomaxillofac Trauma Reconstr. 2011;4(2):69-72.