Mandibular Fracture Management in the ED Differential Diagnoses

Updated: Feb 08, 2022
  • Author: Thomas Widell, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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DDx

Diagnostic Considerations

Mandible fractures account for a significant proportion of maxillofacial injuries. Evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Choosing appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on type and location of the fractures, various open and closed surgical reduction techniques can be utilized. [15]

Mandibular fractures can be classified anatomically, by dentition, by muscle group, and by severity. The fracture may be closed, open, comminuted, displaced, or pathologic. It is important that the imaging modality used identifies the classification, as this will decide definitive treatment. [23]

X-ray projections typically have been used to detect a mandibular fracture but are limited to anteroposterior (AP), lateral, and oblique views in an unstable trauma patient. These views are inadequate to detail the level of fracture displacement, and they show poor detail of the condylar region. Computed tomography (CT) is the imaging modality of choice for assessment of a traumatic mandibular injury and can demonstrate 100% sensitivity in detecting a fracture when multidetector-row CT is performed; this technique reduces motion blur and thus produces accurate coronal and sagittal reconstructions. [23]

Furthermore, reconstructive 3-dimensional CT images gained from planar views allow a better understanding of the spatial relationship of the fracture to other anatomic landmarks. This ensures better appreciation of the severity and classification of a mandibular fracture, which can guide operative planning. [23]

Ultrasonography (US) is another useful modality for detecting a mandibular fracture when the patient is too unstable to be transferred to a CT scanner. However, sensitivity is less when compared to a CT series of images, and US provides limited detail on the fracture pattern. [23]

Magnetic resonance imaging (MRI) can be used to assess soft tissue injury of the temporomandibular joint, but this is unlikely to be a matter of priority when a trauma patient is first assessed. [23]

Differential Diagnoses