JAW (MANDIBLE) FRACTURE |
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DESCRIPTIONA jaw fracture is a complete or incomplete break in the lower jaw (the mandible).
Appropriate health care includes: doctor's or dentist's treatment to manipulate and set the broken bone; hospitalization (sometimes) for anesthesia and surgery to set the fracture and wire the child's jaw together.
SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling of soft tissue surrounding the fracture.
Blood at the base of the child's teeth near the fracture site.
Visible deformity if the fracture is complete and bone fragments separate enough to distort the child's normal facial contours.
Tenderness to the touch.
Numbness around the fracture site (sometimes).
CAUSES
Direct blow (usually) or indirect stress to the bone. Indirect stress may be caused by violent muscle contraction.
RISK FACTORS
Contact sports, especially boxing; history of bone or joint disease; poor nutrition, especially calcium deficiency.
PREVENTING COMPLICATIONS OR RECURRENCEYour child should use appropriate protective equipment, such as a face mask or mouthpiece, when participating in contact sports.
BASIC INFORMATION
MEDICAL TESTSYour own observation of symptoms; medical history and physical exam by a doctor; X-rays of injured area.
POSSIBLE COMPLICATIONSAt the time of injury:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels, or connective tissues.
After treatment or surgery:
Delayed union or non-union of the fracture (rare).
Impaired blood supply to the fracture site.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Proneness to repeated jaw injury.
An unstable or arthritic jaw following repeated injury.
Prolonged healing time if activity is resumed too soon.
Nutritional problems arising because the child's jaw is wired closed.
PROBABLE OUTCOME
The average healing time for this fracture is 6 to 8 weeks.
TREATMENT
FIRST AID
Use instructions for R.I.C.E., the first letters of rest, ice, compression, and elevation. See Appendix 39 for details.
The doctor will realign and set the broken bones either with surgery or, if possible, without. Manipulation should be done as soon as possible after injury.
HOME CARE
Immobilization will be necessary. Mandible fractures usually require wiring the child's jaw together.
Use an ice pack on the child's jaw 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, or a heating pad.
Your child should learn how to "quick-release" the wired teeth for any emergency such as severe coughing or vomiting.
MEDICATION
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation and fixation of bone fragments possible.
Narcotic or synthetic narcotic pain relievers in liquid form for severe pain.
Stool softeners in liquid form to prevent constipation due to a liquid diet.
Liquid acetaminophen (non-prescription) for mild pain after initial treatment.
ACTIVITY
Your child should rest quietly for 2 days, then resume normal activities gradually. The child should not exercise to the point of panting for breath, because breathing may be difficult for a while.
DIET & FLUIDS
During recovery, the child should follow a high-protein liquid diet such as malted milk and eggnog. Add soft foods as the child is able. Most children can handle rich soups, ground meat, whipped potatoes, and gravy.
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has signs or symptoms of a jaw fracture.
Any of the following occur after surgery or other treatment: increased pain, swelling, or drainage in the surgical area; signs of infection (headache, muscle aches, dizziness, or a general ill feeling, and fever; nausea or vomiting; numbness or complete loss of feeling around the jaw; constipation.
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