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Jaw Fracture

Fractures Jaw

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.

Veterinarian
Weight Loss
  • In mandible fractures, patients receiving MMF will have more weight loss and it takes a longer time for them to regain their mouth opening; whereas, higher infection rates are associated with patients receiving rigid internal fixation (RIF).[epainassist.com]
Overeating
  • This type of injury occurs when the athlete goes over the handlebars and falls directly onto the lower jaw or chin hitting a hard surface.[sportsmd.com]
  • "Given his jaw is stable and not displaced, we will assess him further over the coming days to determine whether he will be available to play this Sunday against the Bombers."[afl.com.au]
  • Commonly, pain, swelling, and bruising can be observed over the fracture area. Stiffness of the affected area is also a common complaint. Opening and closing the mouth during eating or speaking can also be difficult and painful.[ohniww.org]
  • However, because the jawbone is mobile, one of the first symptoms can be severe pain over the site of the fracture with opening and closing of the mouth.[facialtraumamd.com]
Chest Pain
  • You have chest pain when you take a deep breath or cough. You may cough up blood. Your arm or leg feels warm, tender, and painful. It may look swollen and red. When should I contact my healthcare provider? You have a fever. You have a bad headache.[drugs.com]
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]
  • 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]
  • 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]
  • 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]
Eruptions
  • You have tried to access: Treatment - this page is only available for Dental Trauma Guide subscribers Eruption and Impaction/Tooth Autotransplantation April 24-25, 2019 / April 26-27, 2019 Read more The New Dental Trauma Guide You have tried to access[dentaltraumaguide.org]
Dizziness
  • These are symptoms of a concussion: Nausea Vomiting Dizziness Confusion Headache Memory loss Loss of consciousness Wait until all of your symptoms are gone and your provider says it’s OK to resume your activity.[fairview.org]
  • To determine if the athlete has any signs and symptoms of concussion , check for the following: • Dizziness • Headache • Confusion • Nausea • Ringing in the ears • Inability to answer simple questions If any of the above symptoms are present, assume that[sportsmd.com]
  • I felt a very sharp pain and was dizzy for a few seconds. I did not end up going to the hospital after the accident but I am now having some difficulty speaking and my jaw feels strange and painful when chewing food.[ohniww.org]
  • To determine if the athlete has a concussion or possible brain injury, the following symptoms may be detected: Dizziness. Headache. Confusion. Nausea. Ringing in the ear. Inability to answer simple questions.[aspetar.com]
Excitement
  • We hope that 2019 will be just as exciting as last year and Read more Autotransplantation of teeth to the anterior maxilla: A systematic review of survival and success, aesthetic presentation and patient-reported outcome Akhlef Y, Schwartz O, Andreasen[dentaltraumaguide.org]
  • “It’s extremely exciting to be able to offer a new medical device that has such a profound impact on the patient experience, surgeon safety and improvements in hospital efficiencies,” said Kevin McIntosh, president of Summit Medical, Inc.[businesswire.com]
  • “I am excited to see this device reach the market and start helping people who suffer from jaw fractures experience a less invasive and more comfortable recovery process.”[twin-cities.umn.edu]

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.

Excessive Drooling
  • It may also be painful and difficult to close the mouth, and excess drooling may occur.[fitnesshealth101.com]

Treatment

  • CONCLUSION: 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]
  • Additional Information Home Treatments: A broken or dislocated jaw will require professional treatment but the initial treatment involves standard first aid principles.[fitnesshealth101.com]
  • All the studies evaluated different aspects of surgical treatment. None of the studies evaluated non-surgical treatments such as intermaxillary fixation and no study compared surgical treatment with non-surgical treatment.[cochrane.org]

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]
  • 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]
  • PROGNOSIS In most cases, the prognosis is good, especially when the fracture is treated promptly and properly.[aspetar.com]
  • Overall, the prognosis is good if the patient follows doctor's instructions, the recommended diet and takes the required antibiotic course and regularly follows up.[epainassist.com]
  • In most cases, the prognosis is very good, especially when the fracture is treated promptly and properly.[thechildren.com]

Etiology

  • Etiology and demographics will vary significantly depending on the population demographics and with where patients present.[radiopaedia.org]
  • Classification, etiology and epidemiology. In Textbook and color atlas of traumatic injuries to the teeth . pp 151–180. 3rd ed. Copenhagen: Munksgaard, 1994. 2. Holan G . Traumatic injuries to the chin: a survey in a paediatric dental practice .[nature.com]
  • . • Studies have shown that the incidence of mandible fractures are influenced by various etiological factors e.g. • • • • Geography Social trends Road traffic legislations Seasons 20. • Site of Fracture: Oikarinen and Malmstrom (1969) analyzed 600 mandible[slideshare.net]

Epidemiology

  • Epidemiology of facial Fractures. Journal of oral and maxillofacial surgeons. June 2011. Widell, Thomas. Mandible Fracture.[twin-cities.umn.edu]
  • OUTLINE • INTRODUCTION • CLASSIFICATION • AETIOLOGY • EPIDEMIOLOGY • SIGNS & SYMPTOMS • INVESTIGATION • MANAGEMENT 3.[slideshare.net]
  • 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]
  • Classification, etiology and epidemiology. In Textbook and color atlas of traumatic injuries to the teeth . pp 151–180. 3rd ed. Copenhagen: Munksgaard, 1994. 2. Holan G . Traumatic injuries to the chin: a survey in a paediatric dental practice .[nature.com]
Sex distribution
Age distribution

Pathophysiology

Prevention

  • Exercise Techniques to Prevent Injury: No known specific exercise techniques to prevent a dislocated or fractured jaw.[fitnesshealth101.com]
  • This model will also have direct implications for strategic planning for prevention and management policies in Australia aimed at reducing the inequalities gap both in terms of geography as well as Aboriginality.[ncbi.nlm.nih.gov]
  • 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]
  • This process is called mandibular-maxillary fixation (MMF) and it prevents the fractured jaw segments from moving with swallowing and chewing.[ohniww.org]
  • 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]

References

Article

  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.

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Last updated: 2017-08-09 17:23