What is the treatment for a fractured jaw?

Treatment of Mandibular Fractures

The cornerstone of mandibular fracture management is surgical debridement with removal of all dead tissues, followed by osseous stabilization through implant retention, exchange, or external fixation, along with appropriate antimicrobial therapy and sufficient soft tissue coverage. 1

Initial Assessment and Classification

• Mandibular fractures should be evaluated for displacement, occlusion status, facial symmetry, and associated injuries 1
• High-resolution CT imaging is preferred for accurate diagnosis of fracture patterns 2
• Fractures may involve the anterior alveolar process, condylar necks, body, symphysis, or coronoid process 3

Treatment Approaches

Conservative Management

• Non-surgical management may be appropriate for:

  • Fractures with minimal or no displacement 4
  • Normal occlusion (or pre-traumatic occlusion) 4
  • Maintained facial symmetry 4
  • Patients with contraindications to surgery 5

• Conservative treatment protocol includes:

  • Soft food and liquid diet for approximately 30 days 4
  • Limited mouth opening 4
  • Oral antibacterial cleaning 4
  • Analgesic therapy as needed 4

Surgical Management

• Surgical intervention is indicated for:

  • Displaced fractures affecting occlusion 1, 5
  • Unstable fractures 1
  • Alveolar fractures with segment mobility 1
  • Fractures with significant functional impairment 5

• Surgical approaches include:

  1. Debridement, Antimicrobial Therapy, and Implant Retention (DAIR) 1

     • Appropriate for early/acute fractures (within 3-6 weeks)
     • Success rates of 70-90% when performed within 6 weeks

  2. Debridement with Implant Removal/Exchange 1

     • Indicated when fracture has healed or requires exchange
     • Necessary when proper debridement cannot be performed with implant in place

• Fixation methods:

  • Intermaxillary fixation (IMF) for patients with adequate dentition 5, 3
  • Interosseous wiring to support unstable fragments 3
  • Plate and screw fixation (miniplates or 3D plates) 5
  • Intramedullary Kirschner wires for edentulous patients 3

Special Considerations

Pediatric Fractures

• Pediatric mandibular fractures generally require less invasive management 6
• Closed reduction is usually sufficient to restore normal anatomy and function 6
• Early treatment is essential for optimal outcomes 6
• Open reduction may be necessary based on pediatric dental anatomy and fracture type 6

Coronoid Process Fractures

• Conservative management is recommended initially for minimally displaced coronoid fractures 7
• Open reduction and internal fixation via modified retromandibular approach is indicated for:
  • Significant fracture displacement 7
  • Limited mouth opening 7
  • Concomitant fractures of the zygoma, zygomatic arch, or mandibular ramus 7

Alveolar Fractures

• Reposition of the segment and stabilization with a splint is indicated 1
• Immediate referral to a dentist is recommended 1

Post-Treatment Care

• Antimicrobial mouth rinses and appropriate antibiotic therapy when clinically indicated 1
• Effective oral hygiene maintenance 1
• Soft diet for the first 10 days post-injury 1
• Regular follow-up to monitor healing and detect complications 1
• Monitoring for signs of infection or non-union 1

Common Pitfalls and Complications

• Delayed treatment may lead to malunion or non-union 6
• Inadequate debridement increases risk of infection 1
• Progressive trismus may develop in some conservatively managed cases 7
• Post-operative infection can occur regardless of plate configuration (single vs. double plates) 5
• Failure to address associated injuries may compromise outcomes 2, 3