Mandibular Fractures
Mandibular fractures are common facial injuries that occur due to trauma to the lower jaw. As a junior doctor in the UK, it is essential to understand the various types, clinical presentation, diagnostic approaches, and treatment options available for these fractures. This guide provides an overview of mandibular fractures and a systematic approach for a junior doctor managing a patient with a suspected mandibular fracture.
Epidemiology and Aetiology:
Mandibular fractures account for approximately 36-70% of all maxillofacial fractures. The most common causes include road traffic accidents, falls, sports-related injuries, and interpersonal violence. Risk factors for mandibular fractures include young age, male gender, and alcohol consumption.
Anatomy and Classification:
The mandible consists of several anatomical regions: the symphysis, body, angle, ramus, coronoid process, and condyle. Fractures can be classified based on the location and the type of fracture.
Clinical Presentation:
Patients with mandibular fractures may present with the following signs and symptoms:
Pain and tenderness at the fracture site
Swelling and bruising
Malocclusion (improper bite)
Trismus (difficulty opening the mouth)
Numbness or paresthesia in the lower lip or chin due to injury to the inferior alveolar nerve
Open wounds or lacerations
Diagnostic Approach:
The diagnostic workup of a patient with a suspected mandibular fracture should include:
History: Obtain a detailed history of the mechanism of injury and assess for potential risk factors.
Physical Examination: Inspect the face for asymmetry, swelling, bruising, and lacerations. Palpate the mandible for tenderness, step deformity, and crepitus. Assess occlusion, mouth opening, and dental injuries. Examine the patient for other injuries or signs of trauma.
Imaging: Obtain a panoramic radiograph (OPG) and/or a computed tomography (CT) scan of the mandible. The CT scan is preferred when the OPG is inconclusive, or if there are multiple or complex fractures.
Treatment:
The goals of mandibular fracture management are to restore normal function, occlusion, and facial aesthetics. Treatment options depend on the type, location, and stability of the fracture, and patient factors. They include:
Conservative Management: Non-displaced or minimally displaced fractures may be managed conservatively using analgesics, soft diet, and close follow-up.
Closed Reduction: Indicated for simple, stable fractures. Techniques include intermaxillary fixation (IMF) using arch bars or other IMF devices. The patient's jaw is immobilized for 2-6 weeks, depending on the fracture site and stability.
Open Reduction and Internal Fixation (ORIF): Indicated for displaced or unstable fractures. This involves surgical exposure of the fracture site and fixation using plates, screws, or wires.
Post-operative Care: Includes pain management, antibiotics, oral hygiene, and regular follow-up.
Referral:
Consult a maxillofacial or oral surgeon for definitive management of mandibular fractures. In the case of complex fractures or associated injuries, a multidisciplinary team approach involving otolaryngologists, plastic surgeons, or neurosurgeons may be necessary.
