Management of Nondisplaced Right Mandibular Fracture
For a nondisplaced mandibular fracture, conservative management with closed reduction using maxillomandibular fixation (MMF) is the appropriate initial approach, as these minimally displaced fractures can be adequately treated without surgical intervention. 1, 2
Initial Diagnostic Workup
Obtain CT maxillofacial with multiplanar reformations as the primary imaging modality, which has nearly 100% sensitivity for detecting mandibular fractures, including subtle nondisplaced fractures that conventional radiography misses (86-92% sensitivity). 1
Search for a second fracture after identifying the first one, as 67% of mandibular fractures occur in pairs due to the U-shaped configuration of the mandible—this is the most critical error to avoid. 1, 3
Obtain CT head to evaluate for intracranial injuries, which occur in approximately 39% of patients with mandibular fractures. 1, 3
Assess for cervical spine injury, present in approximately 11% of mandibular fracture patients, as this commonly overlooked associated injury can have devastating consequences if missed. 1, 3
Clinical Examination Priorities
Evaluate for anesthesia or paresthesia of the lower lip, chin, anterior tongue, and mandibular teeth, which indicates inferior alveolar nerve damage when fractures extend through the mandibular canal. 1
Assess occlusion, jaw mobility, and facial symmetry to determine the functional impact of the fracture. 3
Treatment Approach for Nondisplaced Fractures
Conservative Management (Closed Reduction)
Closed reduction with MMF is indicated for minimally displaced fractures that can be adequately treated without surgical intervention. 2
Use maxillomandibular fixation screws (6-8 screws) to obtain intermaxillary fixation for 5-6 weeks to allow bone healing. 4
MMF screws are cost-effective, saving approximately $600 per patient in operating room costs compared to arch bars, with minimal long-term damage to periodontium and dental roots. 4
When Surgical Intervention Is NOT Indicated
Open reduction and internal fixation (ORIF) is NOT indicated for minimally displaced nondisplaced fractures that can easily and adequately be treated with closed reduction. 2
Avoid surgical intervention if the fracture shows minimal displacement and stable occlusal relationships can be maintained with closed techniques. 2, 5
Immediate Management Priorities
Ensure airway patency, particularly important with bilateral fractures or flail mandible. 1
Control bleeding and provide analgesia as initial supportive measures. 1
Arrange immediate oral and maxillofacial surgery consultation for definitive management planning. 1
Expected Outcomes with Conservative Management
Closed treatment with MMF screws demonstrates adequate fracture healing based on clinical examination in appropriately selected cases. 4
Pre-existing occlusion can be successfully re-established with closed reduction techniques. 4
Mean follow-up visits required are approximately 5.3 visits for closed treatment, comparable to open techniques. 5
Common Pitfalls to Avoid
Do not rely on conventional radiography alone, which will miss subtle fractures and has significantly lower sensitivity (86-92%) than CT (nearly 100%). 1
Do not fail to search for paired fractures, as this is the most critical error given the 67% incidence of multiple fractures. 1
Do not overlook associated cervical spine injuries (6-19% of cases) or intracranial injuries (39% of cases). 1, 3
Do not proceed with ORIF when closed reduction is adequate, as this unnecessarily increases operative time (3.0-3.2 hours vs 1.4 hours) and complication rates (30.6% vs 2.7%). 5
Quality of Life Considerations
Patients treated with closed reduction (MMF) report lower quality of life during the treatment period compared to ORIF due to jaw immobilization, though this is temporary. 4
Minimal pain is associated with MMF screws based on patient-reported outcomes. 4
Sensory disturbances from nerve damage can significantly impact quality of life and may persist if nerve damage is severe, requiring careful monitoring. 3