Diagnosing Mandible Fractures
The mandible (jawbone) is not infrequently fractured in trauma to the lower face. However, even severe injury may not be immediately apparent in the
trauma bay, particularly if the patient is unresponsive. Some tipoffs that a mandible fracture may be present included inability to open the mouth (trismus), loose or avulsed (knocked out) teeth, lacerations in and around the mouth, malocclusion of the jaw, bruising over the jaw, or abnormal sensation over the lower lip and chin.
Oral and maxillofacial surgeons (OMFS) and otolaryngologists (ENT) usually request one of four radiographic studies when a mandible fracture is suspected. A Panorex view usually shows the fracture well but does not reveal the level of soft tissue swelling. Full mandibular films have the advantage of showing both the fracture and the anatomic bony relationships of the entire mandible. With the advent of computed tomography availabe in most emergency rooms, facial CT with “thin cuts” are commonly obtained and occasionally MRI of the mandible and surrounding vascular structures is mandated.
Two additional radiographic studies that almost always obtained when a mandible fracture is suspected (particularly in blunt trauma) are a CT of the head and a CT of the cervical spine.
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