JAW (MANDIBLE) FRACTURE |
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General Information
DEFINITION--A complete or incomplete break in the lower jaw (the mandible). The temporo-mandibular joints (TMJ) are located just in front of the ears. These joints connect the lower jaw with the skull and are used to open and close the mouth. A fracture usually occurs at the condyle, or head of the mandible.
BODY PARTS INVOLVED
Lower jawbone (mandible).
Temporo-mandibular joint.
Soft tissue surrounding the fracture site, including nerves, muscles, tendons, ligaments and blood vessels.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling of soft tissue surrounding the fracture.
Blood at the base of the teeth near the fracture site.
Visible deformity if the fracture is complete and bone fragments separate enough to distort normal facial contours.
Tenderness to the touch.
Numbness around the fracture site (sometimes).
CAUSESDirect blow (usually) or indirect stress to the bone. Indirect stress may be caused by violent muscle contraction.
RISK INCREASES WITH
Contact sports, especially boxing.
History of bone or joint disease, especially osteoporosis.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia are needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENTUse appropriate protective equipment, such as a face mask or mouthpiece, when participating in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's or dentist's treatment to manipulate and set the broken bone.
Hospitalization (sometimes) for anesthesia and surgery to set the fracture and wire the jaw together.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of injured areas.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture (rare).
Impaired blood supply the fracture site.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Proneness to repeated jaw injury.
Unstable or arthritic jaw following repeated injury.
Prolonged healing time if activity is resumed too soon.
Nutritional problems arising because the jaw is wired closed.
PROBABLE OUTCOMEIt is impossible to predict exactly how long it will take for any fracture to heal. Variable factors include age, sex, and previous state of health and conditioning. The average healing time for this fracture is 6 to 8 weeks. Healing is considered complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will realign and set the broken bones either with surgery or, if possible, without. Manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization will be necessary. Mandible fractures usually require wiring the jaw together.
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers or a heating pad.
Learn how to "quick-release" your wired teeth for any emergency such as severe coughing or vomiting.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation and fixation of bone fragments possible.
Narcotic or synthetic narcotic pain relievers in liquid form for severe pain.
Stool softeners in liquid form to prevent constipation due to a liquid diet.
Liquid acetaminophen (available without prescription) for mild pain after initial treatment.
ACTIVITYRest quietly for two days, then resume normal activities gradually. Don't exercise to the point that you pant for breath, because breathing may be difficult for a while.
DIET
Drink only water before manipulation or surgery to treat the fracture. Any food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, follow a high-protein liquid diet such as malted milk and eggnog. Add soft foods as you are able. Most people can handle rich soups, ground meat, whipped potatoes and gravy.
REHABILITATIONNo special rehabilitation program. Begin using jaw muscles carefully after the fracture heals.
CALL YOUR DOCTOR IF
You have signs or symptoms of a jaw fracture.
Any of the following occur after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Nausea or vomiting.
Numbness or complete loss of feeling around the jaw.
Constipation.
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