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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.

Fishing
  • The first 4 weeks following removal of the tight elastics, your diet should involve soft foods (eggs, potatoes, fish, pasta, etc). Here are some tips to creating a personal menu: You may eat anything that can be thinned into liquid form.[northfraseroms.com]
  • Starting in your second month after surgery you can move to soft foods like soft rice dishes, chicken noodle soup, baked fish cut up into very small pieces, scrambled eggs, pie, and heartier soups.[snorenet.com]
Movement Disorder
  • Some physical therapists have a practice with a craniofacial focus, meaning that they focus on movement disorders related to the skull and facial structures.[moveforwardpt.com]
Veterinarian
Sore Throat
  • SORE THROAT For the first couple of days following surgery you may experience a sore throat and some nasal congestion. This is normal after general anaesthesia and should go away within a couple of days.[harboursidesurgical.com]
  • SORE THROAT: For the first couple of days following surgery you may experience a sore throat and some nasal congestion. This is normal after anesthesia and should go away within a couple of days.[northfraseroms.com]
  • Sore Throat It is possible that once you come out of the surgery you will have a sore throat. This is because of the airway tube has agitated your throat. Try gargling with salt water if you can. Throat lozenges will help too.[snorenet.com]
  • Sore throats and pain when swallowing are not uncommon following surgery. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in a few days.[oralsurgerycolumbiamo.com]
Nasal Congestion
  • SORE THROAT: For the first couple of days following surgery you may experience a sore throat and some nasal congestion. This is normal after anesthesia and should go away within a couple of days.[northfraseroms.com]
  • SORE THROAT For the first couple of days following surgery you may experience a sore throat and some nasal congestion. This is normal after general anaesthesia and should go away within a couple of days.[harboursidesurgical.com]
  • Nasal Congestion If you are having any upper jaw procedures your nose could be congested. For the first 3-4 days you can use a nasal decongestant as well as oral decongestant.[snorenet.com]
Cough
  • 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]
  • This includes vomiting, extreme coughing, or choking. You must carry a pair of small wire-cutters with you at all times. Keep them near your bed at night. Be sure you know which wires to cut in case you need to do this.[fairview.org]
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]
Poor Oral Hygiene
  • Alcoholism Metabolic and nutritional deficiencies Contributing factors may include (1) poor oral hygiene and dental or periodontal infections, (2) teeth in the fracture line, (3) alcohol abuse and chronic disease (4) poor patient compliance, and (5) displacement[snorenet.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]
Neglect
  • Broken jaws typically occur from some unexpected physical injury or trauma, but that's not an excuse to neglect a proper oral healthcare routine. Daily flossing and brushing with a toothpaste such as Colgate Total Advanced Fresh Whitening are musts.[colgate.com]
Forgetful
  • And don't forget regular checkups with your dentist.[colgate.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

  • 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]
  • Mizrahi has cultivated a reputation for beautiful jaw fracture treatment in Beverly Hills. Meet Dr.[beverlyhillsoralsurgerycenter.com]
  • Treatment is started with antibiotics. Patient is given a tetanus shot and pain killers are prescribed.[epainassist.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]
  • PROGNOSIS In most cases, the prognosis is good, especially when the fracture is treated promptly and properly.[aspetar.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]
  • 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

  • A study conducted by Kolli Yada Giri and colleagues aimed at determining the etiological factors behind the high incidence of mandibular fractures in the Rohilkhand region, Uttar Pradesh.[medindia.net]
  • Etiology and demographics will vary significantly depending on the population demographics and with where patients present.[radiopaedia.org]
  • Major etiologic factors vary based on geographic location.[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

  • 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]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology High impact trauma to the neck or face is a potential risk for BCI.[jmedicalcasereports.biomedcentral.com]
  • 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]
  • […] 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]
  • You may also be given a prescription for a liquid antibiotic to prevent infection. It is important to take this medication as prescribed until it is finished. A prescription for an anti-bacterial mouth rinse will be given.[harboursidesurgical.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: 2019-07-11 22:25