Wednesday, August 1, 2018

Mandibular Fractures

emDocs- July 30, 2018 - Author: Brubaker S - Edited by: Koyfman A and Long B
  • Mandibular fractures can lead to significant bleeding and/or swelling that can result in airway compromise. Have suction and advanced airway equipment easily accessible. 
  • Physical exam findings can be subtle, so perform a detailed exam if the mechanism suggests possible mandibular fracture (most common mechanism is assault, followed by MVC). 
  • Most sensitive exam maneuver: tongue-blade test (95% sensitive). 
  • Maxillofacial CT is generally the first-line imaging modality. 
  • Search diligently for evidence of open fracture, and have a low threshold to treat with antibiotics. Some recommend treating all mandibular fractures with prophylactic antibiotics. 
  • Most patients with mandibular fractures can be discharged with follow-up in 48-72 hours. Arrange 24 hour follow-up for patients with tooth avulsions or grossly displaced fractures. Admit patients for pain control, airway management, or inability to tolerate PO intake. 
  • Involve a consultant in determining the disposition for all patients with facial fractures."