Management of Fractures of Jaws/Face
The most frequently fractured of the facial bones is the mandible. Pathological fractures, the indirect result of disease, are not uncommon, but the majority of mandible fractures are traumatic. The advent of the high-speed automobile has changed our ideas of the etiology of fractures of the facial bones but, with rubber and gas rationing and reduced speeds, this hazard will be largely eliminated, at least for the duration, and fists and falls will probably take first place as causes of mandible fractures in civilian practice. War injuries, unfortunately, will be of severe type, taxing the skill and ingenuity of the surgeon.
Fractures of the mandible may be partial, involving the alveolar processes or individual teeth, or they may be complete and of the same varieties as fractures of other bones—single, double, or comminuted.
Single fractures occur most frequently, predominating over double fractures in the ratio of two to one. They are located at the angle or the mental foramen. Of the double fractures, those occurring at the angle on one side and mental foramen on the other are by far the most common (about 75 per cent). Fractures in the region of the symphysis menti or condyle are less frequent. The sites of predilection, in the order of their frequency, are the angle, mental foramen, molar region, symphysis, condyle, and coronoid process.
Areas of anatomic weakness in the mandible determine the location of a fracture. In children with unerupted teeth the cuspid region is most frequently the site of fracture. Fractures of the body of the mandible when teeth are present are invariably compound.
The diagnosis of fracture of the jaw is usually not difficult. There is a history of injury and the patient often presents a characteristic appearance; the head is carefully held, with the mouth open and an increased flow of saliva and drooling because of pain elicited by the muscular pull on fragments and a natural disinclination to swallow. There is some swelling; localized pain is variable but may be severe. Difficulty in opening or closing the jaws may be due to disinclination or to the displacement of fragments. Because of this displacement, the alignment of the jaws may be disturbed, with abnormal occlusion of the teeth. Anesthesia of the lower lip and gums may be discovered.
Unnecessary movement of parts should be avoided, but crepitus may be elicited and a false point of motion felt. X-ray examination is the best means of determining the extent of injury. It is possible to examine the entire mandible from the temporo-mandibular joint on one side, around the jaw, to the joint on the other side, and this examination should be made in every case.
Treatment of Fracture of the Mandible
The objectives of treatment are the care of the injured soft tissues to prevent or minimize infection and the reduction of fragments to normal position, which usually results in the restoration of occlusion of the teeth. The restoration of the normal tooth occlusion is of the greatest importance in gaining a good functional result.