Dislocated or fractured jaw
Dislocated or fractured jaw: Excerpt from Professional Guide to Diseases (Eighth Edition)
Dislocation of the jaw is a displacement of the temporomandibular joint. A jaw fracture is a break in one or both of the two maxillae (upper jawbones) or the mandible (lower jawbone). Treatment can usually restore jaw alignment and function.
Causes
Simple fractures or dislocations are usually caused by a manual blow along the jawline; more serious compound fractures commonly result from automobile accidents. Other causes include industrial accidents, recreational or sports injuries, assaults, or other trauma. Recurrence of a dislocated jaw is common.
Signs and symptoms
Malocclusion is the most obvious sign of a dislocation or fracture. Other signs include mandibular pain, swelling, ecchymosis, loss of function, and asymmetry. In addition, mandibular fractures that damage the alveolar nerve produce paresthesia or anesthesia of the chin and lower lip. Maxillary fractures produce infraorbital paresthesia and commonly accompany fractures of the nasal and orbital complex.
Diagnosis
CONFIRMING DIAGNOSIS Abnormal maxillary or mandibular mobility during the physical examination and a history of traumatic injury suggest a fracture or dislocation; X-rays confirm it.
Treatment
As in all traumatic injuries, check first for a patent airway, adequate ventilation, and pulses; then control hemorrhage and check for other injuries. As necessary, maintain a patent airway with an oropharyngeal airway, nasotracheal intubation, or a cricothyrotomy. Relieve pain with analgesics as needed.
After the patient stabilizes, surgical reduction and fixation by wiring restores mandibular and maxillary alignment. Maxillary fractures may also require reconstruction and repair of soft-tissue injuries. Teeth and bones are never removed during surgery unless unavoidable. If the patient has lost teeth from trauma, the surgeon will decide whether they can be reimplanted. If they can, he’ll reimplant them within 6 hours, while they’re still viable. Viability is increased if the tooth is placed in milk, saliva, or normal saline solution. Dislocations are usually reduced manually under anesthesia.
Special considerations
After reconstructive surgery, perform the following:
❑ Position the patient on his side with his head slightly elevated. He’ll usually have a nasogastric tube in place, with low suction to remove gastric contents and prevent nausea, vomiting, and aspiration of vomitus. As necessary, suction the nasopharynx through the nose or by pulling the cheek away from the teeth and inserting a small suction catheter through any natural gap between teeth.
❑ If the patient isn’t intubated, provide nourishment through a straw. If he has a natural gap between his teeth, insert the straw there; if not, one or two teeth may have to be extracted. After the patient can tolerate clear liquids, offer milkshakes, broth, juices, pureed foods, and nutritional supplements.
❑ If the patient can’t tolerate oral fluids, I.V. therapy can maintain hydration postoperatively.
❑ Administer antiemetics as ordered to minimize nausea and prevent aspiration of vomitus (a real danger in a patient whose jaw is wired). Keep a pair of wire cutters at the bedside to snip the wires should the patient vomit.
❑ A dental water-pulsator may be used for mouth care while the wires are intact.
❑ Because the patient will have difficulty talking while his jaw is wired, provide a Magic Slate or pencil and paper and suggest appropriate diversionary activities.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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