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Jaw fracture
Last reviewed: 07.07.2025
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Blunt trauma to the face can cause a fracture of the jaw and other bones of the facial skeleton.
A jaw fracture is suspected in patients with newly developed malocclusions or localized swelling and pain over the lower jaw. Palpation reveals instability of some fractures. A fracture of the condyle of the lower jaw is characterized by: pain in front of the ear, swelling, and limited mouth opening. In the case of a unilateral fracture of the condyle of the lower jaw, the latter deviates to the damaged side when opening the mouth.
Fractures of the midface, which includes the area from the superior orbital rim to the maxillary teeth, may disrupt the contours of the cheeks, zygomatic eminences, zygomatic arch, and orbital margins, and cause numbness in the infraorbital region. Enophthalmos and diplopia indicate a fracture of the orbital floor. Le Fort's classification can be used to describe maxillary fractures. With a fairly severe injury with facial fracture, TBI and cervical spine fractures are possible. With large depressed facial fractures, airway obstruction may occur due to swelling and hemorrhage.
In case of isolated fracture of the lower jaw, panoramic dental radiography should be performed. Standard radiographs (anteroposterior, oblique, occlusal, projections according to Waters and Towne) are informative when a fracture of the facial skull is suspected, but, if possible, CT should be used, which is advisable to perform even if the fracture is clearly visible on conventional radiographs.
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Treatment of jaw fracture
Oral intubation of the trachea may be required to maintain a patent airway in patients with hemorrhage, edema, or extensive tissue damage. Definitive treatment of facial fractures is labor-intensive and may involve osteosynthesis.
Jaw fractures that pass through the dental sockets are considered open. In these cases, antibiotic prophylaxis is indicated, either orally or parenterally.
In case of fractures of the lower jaw, intermaxillary or rigid open fixation is used. If fixation is possible within the first hour after the injury, suturing of any wounds of the lips and mouth should be postponed until its completion. For intermaxillary fixation, special arched splints are used, which are fixed on the teeth of each jaw, after which the bite is restored and the splints are connected with wire. The patient should always have nippers with him in case of vomiting. Nutrition is limited to liquids, purees and food additives. Since only the outer surface of the teeth can be cleaned, daily rinses with 30 ml of 0.12% chlorhexidine solution for 60 seconds in the morning and evening are recommended to the patient to prevent plaque, infection and bad breath. Mouth opening exercises usually help to restore function after the fixators are removed.
Condylar fractures require external fixation for no more than 2 weeks.
However, in bilateral condylar fractures with significant displacement, open reposition and fixation may be required. In condylar fractures in children, rigid external fixation should not be used due to the risk of ankylosis of the temporomandibular joints and facial developmental anomalies. Elastic fixation for 5 days is usually sufficient.