Jaw fractures are one of the most common maxillofacial injuries encountered in medical practice, with pain, numbness, bleeding, restricted mobility and in rare cases dyspnea presenting as main symptoms. Panoramic radiography and helical computed tomography are the imaging techniques used to make the diagnosis.
Presentation
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.
Entire Body System
- Dentist
The plaintiff claimed that she had requested that the defendant dentist not perform the procedure, but he did. [dentists-advantage.com]
Dear Jeremy, Well, first off you really should see your dentist without delay. He/she will need to do a proper examination in order to access the situation directly. [deardoctor.com]
Dentists could play a role in identifying the TMJ complication in children with JIA. [ntvt.nl]
So, if you find the above-stated symptoms then immediately consult a dentist, who will take care of the things and will recommend the immediate tests, following which, he will start the treatment. [jpmaxface.com]
And don't forget regular checkups with your dentist. [colgate.com]
- Weakness
The results showed that 5-8 months after insertion of the plates and screws, there was weak cellular activity within the scar tissue overlying the plates without inflammatory cells. Most of the titanium particles were located extracellularly. [ncbi.nlm.nih.gov]
Some people have especially weak temporomandibular joints, so that opening the mouth very widely—for example during yawning or eating a large sandwich—may cause the jaw to dislocate. [healthcommunities.com]
Facial Weakness. Sometimes, in order to get good access to repair the broken jaw, we have to go through the cheek. The nerve making the facial muscles move (the Facial Nerve) may be traumatized as a result. [exodontia.info]
- Severe Pain
The pain can in fact be severe enough that the mouth can only be opened a small amount, a condition referred to as “trismus”. Chewing will be extremely difficult and painful. [facialtraumamd.com]
Search thousands of topics on CostHelper.com CostHelper > Health & Personal Care > Orthopedics and Injuries > Broken Jaw A broken jaw can be a very serious injury that can cause severe pain, swelling, numbness, bleeding, and difficulty chewing and talking [health.costhelper.com]
I think I should have let pain be my guide. Though my daughter had pain, it likely wasn't severe enough pain for her jaw to have been broken. I was worried when she complained that her bite didn't feel right. [wehavekids.com]
For severe pain, 2-3 teaspoons of the prescribed liquid narcotic medication (hydrocodone/acetaminophen) should be taken as needed. It is best to take pain medication with a small snack or following a meal to avoid stomach upset. [foleyoralsurgery.com]
- Disability
However, given how painful and disabling jaw wiring is, any alternative effective options should be sought. Currently, there are a few surgeons who are able to repair jaw fractures without wiring. [ohniww.org]
Please enable JS and disable any ad blocker [veterinarycalendar.dvm360.com]
Early diagnosis and prompt anticoagulation therapy have reduced the occurrence of ischemic neurologic events and disability. [jmedicalcasereports.biomedcentral.com]
With most trauma resuscitation, the obvious injuries are appreciated but take second stage to the injuries that are lethal or permanently disabling. [mddirect.org]
- Fatigue
Excessive fatigue can also slow the healing process as well as increase the chance of infection by reducing your resistance. A gradual increase back to normal activity is the most sensible approach. [harboursidesurgical.com]
Following a TMJ fracture, you may experience: Jaw pain Swelling and possible bruising in the area Jaw fatigue Difficulty opening your mouth to eat or talk Ringing in your ears Dizziness Headache Loose or broken teeth Popping sounds in your jaw Neck pain [moveforwardpt.com]
Jaw & Teeth
- Jaw Pain
Chronic jaw pain results from a variety of conditions: teeth-grinding, TMJ, periodontal disease and even certain sinus issues. Of course, pain can also be caused by a fractured jaw you're unaware of. [colgate.com]
Minimally displaced left parasymphyseal jaw fracture. Top: Left jaw oblique; Bottom: Panorex The patient found that wearing the splint alleviated all of her pain. [ncbi.nlm.nih.gov]
Medical Treatment Many people who have jaw pain will not have a jaw fracture and will be treated with pain medications and instructions to eat a soft diet and to follow up with their doctor. Those with fractures require further evaluation. [webmd.com]
- Prognathism
Class III (prognathic) Mesiobuccal cusp is distal or posterior to the buccal groove. 27. [slideshare.net]
[…] recommended for medical reasons or where adequate physiotherapy is impossible Bilateral condylar fractures associated with comminuted midfacial fractures Bilateral subcondylar fractures with associated gnathologic problems, such as (1) retrognathia or prognathism [emedicine.medscape.com]
Skin
- Ulcer
Do not take Ibuprofen if you are intolerant of this medication or have a history of stomach ulcers or kidney disease. For severe pain, 2-3 teaspoons of the prescribed liquid narcotic medication (hydrocodone/acetaminophen) should be taken as needed. [foleyoralsurgery.com]
- Urticaria
जाते, तेव्हा खालील दुष्परिणाम आढळतात - Sleepiness Drowsiness Increased blood pressure Allergic reaction Swelling पोटदुखी सौम्य मलावरोध मध्यम Bloody Urine Nausea or vomiting Belching कोरडे तोंड सौम्य Paresthesia ताप सौम्य Chills Infection केस गळणे सौम्य Urticaria [myupchar.com]
Musculoskeletal
- Contusion
Not too long ago, Jermichael Finley of the Green Bay Packers lay on the field with a spinal cord contusion. The cervical spine was not fractured but the cord was injured, the reverse situation for Mr. Huber. [mddirect.org]
The extraoral examination revealed no lacerations or contusions in the region of the chin or parasymphyseal zone. [nature.com]
40% associated with significant injury, 10% of which are lethal Cerebral contusion is common ABC’s! Almost never emergent 82. [slideshare.net]
- Neck Pain
Following a TMJ fracture, you may experience: Jaw pain Swelling and possible bruising in the area Jaw fatigue Difficulty opening your mouth to eat or talk Ringing in your ears Dizziness Headache Loose or broken teeth Popping sounds in your jaw Neck pain [moveforwardpt.com]
Neurologic
- Irritability
Any sharp wires that irritate the inside of your lips and cheeks can be covered with a small pinch of soft wax. This wax is available at the time of discharge, and the nurses in our office can supply you with additional wax as needed. [cumberlandsurgicalarts.com]
It is quite common for the wires and braces to irritate gum and cheek tissue. If your wires begin to bother you, at your follow-up visit, ask your Doctor for some wax, which can be placed over wires to provide relief from irritation. 5. [doctorsteinbeck.com]
Minne Ties sutures have a smooth clasp head, are blunt-tipped, more comfortable than metal wiring, and promise to reduce gum irritation and dental hygiene problems. [twin-cities.umn.edu]
Any sharp wires that irritate the inside of your lips and cheeks can be covered with a small pinch of soft wax. This wax is available at the time of hospital discharge, and the nurses in our office can supply you with additional wax as needed. [foleyoralsurgery.com]
Workup
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.
Treatment
Abstract Abstract – The possible relation between treatment delay and healing complications in mandibular fracture treatment (excluding condylar fractures) was reviewed systematically. Twenty‐two studies were identified. [doi.org]
Orthodontists, as well as oral surgeons, participate in every stage of the treatment of jaw fractures, including treatment decisions, in-patient management, dietary guidance, etc. [ncbi.nlm.nih.gov]
Treatment starts after the radiography, where the patient might feel jeopardized by the effect. Treatment has three steps involved. The first one is the force application to set the bones. [jpmaxface.com]
Prognosis
BACKGROUND: A large number of studies and clinical cases show that an ideal prognosis for mouth function cannot be obtained without sufficient and reasonable postsurgical functional exercise after jaw fracture. [ncbi.nlm.nih.gov]
Such fractures have an excellent prognosis and are usually repaired with intra-oral wiring. The wires often need to extend back into the mouth through a hole drilled in the interdental space or around the second pre-molar. [kannegieterequine.com]
In most cases, the prognosis is very good, especially when the fracture is treated promptly and properly. [thechildren.com]
As a DTG member you get: animation based treatment individual prognosis determination the trauma pathfinder newsletter service along with abstract from recent dental trauma studies free download of 30 clinical studies. and last but not least a 10 % discount [dentaltraumaguide.org]
Etiology
In contrast, investigators in other countries, such as Sweden, Canada and Bulgaria, report assault as being the commonest etiology. [news-medical.net]
Etiology and demographics will vary significantly depending on the population demographics and with where patients present. [radiopaedia.org]
Alcohol abuse plays a major role in the etiology of mandibular fractures. It results in a higher rate of complications either secondary to noncompliance or as a result of metabolic dysfunction. [emedicine.medscape.com]
Paediatric maxillofacial fractures: their etiological characters and fracture patterns. J Craniomaxillofac Surg, 30 (2002), pp. 237-241 [9] H.G. Luhr. On the stable osteosynthesis in mandibular fractures. [elsevier.es]
Epidemiology
OUTLINE • INTRODUCTION • CLASSIFICATION • AETIOLOGY • EPIDEMIOLOGY • SIGNS & SYMPTOMS • INVESTIGATION • MANAGEMENT 3. [slideshare.net]
Epidemiology of facial Fractures. Journal of oral and maxillofacial surgeons. June 2011. Widell, Thomas. Mandible Fracture. http://emedicine.medscape.com/article/825663-overview#a6 [twin-cities.umn.edu]
Epidemiology Fractures of the mandible are common. [ 1 ] The most commonly fractured sites are the body of the mandible, condyle, angle, symphysis, ramus and the coronoid process. [patient.info]
The Epidemiology of Mandibular Fractures in the United States, Part 1: A Review of 13,142 Cases from the US National Trauma Data Bank. J Oral Maxillofac Surg. 2015 Dec. 73 (12):2361-6. [Medline]. Vaillant JM, Benoist M. [emedicine.medscape.com]
Pathophysiology
PATHOPHYSIOLOGY Optimal mandible function requires maintenance of normal anatomic shapeshape and stiffnessand stiffness (ie, resistance to deformation underload). 13. PATHOPHYSIOLOGY Fractures result secondary to mechanical overload. [slideshare.net]
Pathophysiology High impact trauma to the neck or face is a potential risk for BCI. [jmedicalcasereports.biomedcentral.com]
[…] associated injuries before the mandible fracture could be treated. [30] Number of fractures per mandible In patients with mandible fractures, 53% of patients had unilateral fractures, 37% of the patients had 2 fractures, and 9% had 3 or more fractures. [29] Pathophysiology [emedicine.medscape.com]
Prevention
This process is called mandibular-maxillary fixation (MMF) and it prevents the fractured jaw segments from moving with swallowing and chewing. [ohniww.org]
She was treated conservatively with a soft diet and told to avoid doing things that hurt to prevent movement at the fracture site. [ncbi.nlm.nih.gov]
How Jaw Dislocation or Fracture Is Treated Medications to lessen pain and anxiety and to prevent infection before and after surgery, if indicated. A simple dislocated jaw often may be guided or manipulated back into place. [healthcommunities.com]
Since the jaw is likely to slip back into place quickly, it is essential to prevent the anterior teeth from being traumatically fractured. [waybuilder.net]
References
- 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.
- 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.
- 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.
- 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
- Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
- Perez R, Oeltjen JC, Thaller SR. A Review of Mandibular Angle Fractures. Craniomaxillofac Trauma Reconstr. 2011;4(2):69-72.