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