This extends what has already been said in Section 62.1, on the care of a severe maxillofacial injury. If possible, consult a dentist early.
EXAMINATION Feel both the patient’s condyles with the tips of your fingers, and then continue feeling downwards along the borders of his mandible. Feel for tenderness, step defects, alterations in contour, and crepitus.
Look inside his mouth with a good light. Gently swab away any clotted blood. Lift any loose pieces of tooth and alveolus out of his mouth.
Examine his buccal and lingual sulci. Bruising in his buccal sulcus does not necessarily indicate a fracture, but bruising in his lingual sulcus almost certainly does. Palpate his mandible down the whole length of each sulcus carefully. If you suspect a fracture, can you make the fragments move relative to one another?
Examine the patient’s ears for bleeding. Put both your little fingers into them and compare the movement of his condyles. If you cannot feel a condyle moving, suspect a fracture.
BITE AND MOVEMENTS Examine the patient’s bite. If he can cooperate, ask him to carry out a full range of mandibular movements, and note any pain and limitation of movement.
Test for anaesthesia of his mental nerve. Is he anaesthetic below his lower lip to one side of the midline?
X–RAYS Take antero–posterior, and right and left lateral oblique views to show his rami, condyles, and coronoid processes.
SOFT TISSUE INJURIES Do a careful wound toilet inside and outside his mouth. Remove any foreign bodies and all loose teeth in the line of the fracture, together with their roots. If there is loss of soft tissue, stitch his mucous membrane to the skin around the defect as best you can.
ANTIBIOTICS If a patient has an open fracture, give him an antibitoic, such as amoxycillin, ampicillin, or fortified procaine penicillin, daily for 5 days in the hope of preventing bone infection.
BANDAGES are usually unnecessary. If a patient needs one, apply a simple suspensory barrel bandage, not a four–tail bandage.
METHODS FOR PARTICULAR FRACTURES Apply the appropriate methods for fractured condyles (62.8), for fractures of the ramus (62.9), and for fractures of the body of the mandible (62.10). The coronoid processes (C, Fig. 62-15) can also be fractured, but the diagnosis is difficult. The treatment is active movements, so disregard this fracture.
