mandibular fracture
Post on 16-Jul-2015
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19yo Skateboarder presents after falling face first down staircase while trying to jump a railing. C/O pain opening mouth and numbness to lower lip.
T 98 HR 95 BP 150/80 RR 16 PO2 100%
HEENT: PEERLA, EOMI, ecchymosis under tongue, positive tongue blade test, decreased sensation to lower lip,diffuse swelling b/l to jaw, 1.5cm laceration to buccal mucosa on right
Star: Ramus Fx
Triangle: Parasymphyseal fx Arrow: Linear Fx
Open FractureAdmit for IV AbxClindamycin or
PenicillinBarton Bandage for
comfortClosed Reduction
with wiring vs open reduction with internal fixation
Closed FractureOMFS c/sUsually outpatient
managementReduction and
StabilityBarton Bandage for
comfort
Common LocationCondyle 36%Coronoid 2%Ramus 3%Angle 20%Body 21%Alveolar 3%Symphyseal 1%Parasymphyseal 14%
Imaging OptionsPanorex, Towne, Lateral,
Oblique, CTCheck for intraoral
lacerations=open fxMultiple Mandible
Fractures CommonAny fx near
teeth=compound and needs abx
Tongue Blade TestScreening test for Mandibular FractureHave patient bite tongue blade, rotate laterallyIf fracture is present, pain will be so intense that patient
will not be able to continue biting and the blade will NOT break
Test is 96% sensitive for mandibular fx, great way to avoid imaging in select patients
Panorex of Mandible Angle Fx
Minimally displaced fx on CT
http://img.tfd.com/MosbyMD/thumb/mandible.jpg Chang, E. General Principles of Mandible Fracture and Occlusion.
Medscape www.urmc.rochester.edu/smd/rad/neurocases/Neurocase322.htm Tintanelli’s Emergency Medicine: A Comprehensive Study Guide.
Chapter 257 Maxillofacial Trauma Mettler. Essentials of Radiology. 2nd edition. Facial Fracture Chapter Rhea, J. How to Simplify the CT diagnosis of LeFort Fractures.AJR,
2005.184: 1700-1705. Alonso LL, Purcell TB. Accuracy of the tongue blade test in patients
with suspected mandibular fracture. J Emerg Med. 1995 May-Jun;13(3):297-304
https://www.acep.org/content.aspx?id=39806
http://img.tfd.com/MosbyMD/thumb/mandible.jpg Chang, E. General Principles of Mandible Fracture and Occlusion.
Medscape www.urmc.rochester.edu/smd/rad/neurocases/Neurocase322.htm Tintanelli’s Emergency Medicine: A Comprehensive Study Guide.
Chapter 257 Maxillofacial Trauma Mettler. Essentials of Radiology. 2nd edition. Facial Fracture Chapter Rhea, J. How to Simplify the CT diagnosis of LeFort Fractures.AJR,
2005.184: 1700-1705. Alonso LL, Purcell TB. Accuracy of the tongue blade test in patients
with suspected mandibular fracture. J Emerg Med. 1995 May-Jun;13(3):297-304
https://www.acep.org/content.aspx?id=39806
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