From the Guidelines
The management of mandible fractures involves a comprehensive approach, including pain control, prophylactic antibiotics, and definitive treatment with open reduction and internal fixation (ORIF) for most cases, as supported by recent evidence 1.
Initial Management
Initial management of mandible fractures includes pain control with NSAIDs like ibuprofen (400-600mg every 6 hours) or acetaminophen (1000mg every 6 hours), possibly combined with opioids for severe pain. Prophylactic antibiotics such as amoxicillin-clavulanate (875/125mg twice daily) or clindamycin (300mg four times daily) for penicillin-allergic patients are typically prescribed for 5-7 days to prevent infection, especially in open fractures.
Definitive Treatment
Definitive treatment depends on fracture displacement and stability. Non-displaced, stable fractures may be managed conservatively with a soft diet for 4-6 weeks and close follow-up. However, most mandible fractures require surgical intervention with ORIF using titanium plates and screws to restore proper occlusion and function, as fractures of the mandible comprise a large proportion of facial fractures and are vulnerable to low-energy forces 1.
Post-Treatment Care
Following treatment, patients should maintain oral hygiene with chlorhexidine rinses, adhere to a soft or liquid diet for 4-6 weeks, and attend regular follow-up appointments to monitor healing. It is also crucial to seek and exclude a second fracture after the first fracture is detected, considering patterns like a mandibular angle or subcondylar fracture with a contralateral parasymphyseal fracture, and to be aware of potential damage to the inferior alveolar nerve 1. Complications like malocclusion, infection, or non-union require prompt attention. This approach aims to restore mandibular function while minimizing complications and preserving quality of life.
From the Research
Management of Mandible Fractures
The management of mandible fractures can be achieved through various techniques, including open (surgical) and closed (non-surgical) methods 2. The choice of treatment depends on the location and severity of the fracture, as well as the patient's overall health and medical history.
Treatment Options
- Open reduction internal fixation (ORIF) is a common treatment method for mandible fractures, which involves the use of plates and screws to stabilize the fracture site 2, 3.
- External fixation is another option, which involves the use of a uniphasic or biphasic system to reduce and stabilize the fracture 4.
- Maxillomandibular fixation screws (MMFS) is a method that uses screws to fix the mandible to the maxilla, reducing the need for arch bars and circumdental wires 5.
- Surgical treatment of dislocated condylar process fractures can be achieved through open reduction and fixation, employing steel wires and maxillomandibular fixation 6.
Antibiotic Prophylaxis
The use of antibiotic prophylaxis is important in reducing the risk of postoperative wound infection, which is a common complication of mandible fracture repair 3. The choice of antibiotic regimen should cover both potential aerobes and anaerobes.
Outcomes and Complications
The outcomes of mandible fracture treatment can vary depending on the treatment method and the severity of the fracture. Complications such as postoperative wound infection, malocclusion, and temporomandibular joint disorders can occur 2, 3. The use of high-quality evidence-based treatment methods can help minimize the risk of complications and improve patient outcomes.