62.7 The general method for an injured lower jaw

A patient is hit on his jaw. One or more fractures tear the mucoperiosteum covering the body of his mandible. He dribbles bloody saliva, and can neither speak, swallow, nor close his teeth normally. Moving his injured jaw may be so painful that he holds it in his hands. If you move it gently for him, you may be able to feel crepitus.

Mandibular fractures can be unilateral or bilateral. The weak parts of the bone and the common sites for fractures are: (1) the neck of the condyles (B in Fig. 62-15), (2) the angles of the mandible (E, and F), and (3) the premolar region (G). Fractures of the angle and body of the mandible are open, but not those of the rami, condyles, or coronoid processes. Often, the patient has other injuries too, and the combination of a jaw injury and a head injury is common. But, provided there is no gross comminution or tissue loss, you should be able to treat most of these fractures successfully. The mandible remodels readily, even after a comminuted fracture, and left untreated, many fractures will heal themselves, but only with considerable disability.

The purpose of the mandible is to bite, so decide whether or not the patient has a normal bite. If he has not, think how best you can restore it. The methods described below are for single fractures. You will have to adapt them for multiple ones.

Figure 62.14: PATTERNS OF MANDIBULAR FRACTURES. The principle of reducing these fractures is to make the patient’s bite normal.