Jaw Dislocation or Fracture

Jaw dislocation is a displacement of the temporomandibular joint. 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 often result from car accidents and penetration injuries.

Signs and symptoms

Dislocated or fractured jaw may show malocclusion (most obvious sign); 

• Mandibular pain; 
• Swelling; ecchymosis; 
• Loss of function; 
• Asymmetry; 
• Possibly anesthesia or paresthesia of the chin and lower lip with mandibular fracture, or infraorbital (lying under or on the floor of the orbit) paresthesia with maxillary fractures.

Diagnosis

Abnormal maxillary or mandibular mobility during physical examination and a history of trauma suggest fracture or dislocation. X-rays can confirm diagnosis but a computed tomography scan is usually necessary for accurate diagnosis and ultimate repair.

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 tracheotomy. 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 will reimplant them within 6 hours, while they're still viable. Viability is increased if the tooth is placed in milk. Dislocations are usually manually reduced under anesthesia.

Prevention

• Apply an ice pack to the jaw during the first 12 to 24 hours to relieve pain and swelling. Put ice in a plastic bag and place a towel between the ice pack and your skin. Keep the ice pack on your jaw for 15 to 20 minutes out of every hour.
• If you need to yawn, put your fist under your chin to keep you mouth from opening up too wide.
• For the first few days, you may need to wear a bandage to hold the jaw in place.