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Mandibular and Temporomandibular Joint Injuries

Basic Science and Pathophysiology

The Temporomandibular Joint

Clinical Assessment and Risk Stratification

Risk Stratification

Investigations 1

Investigations 2

Management of Mandibular Fracture

Antibiotic Prophylaxis in Open Mandibular Fracture

Reduction of the Dislocated Mandible

Post Reduction Investigations and Advice

Mandibular and Temporomandibular Joint Injuries

Mandibular and Temporomandibular Joint Injuries

Mandibular and Temporomandibular Joint Injuries
Mandibular and Temporomandibular Joint Injuries

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Question 1 of 10

1. Question
1 point(s)

Considering the incidence and type of mandibular fractures presenting to the emergency department (ED), which one of the following statements is true?

Mandibular fracture is an uncommon facial fracture; zygomatic, nasal and maxillary fractures are more frequent
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Injuries sustained in road traffic accidents are the most common cause of mandibular fracture
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In majority of mandibular fractures there are multiple fracture sites
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Approximately one-third of mandibular fractures occur to the body of the mandible
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Other facial fractures are rarely found in association with mandibular fracture
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Question 2 of 10

2. Question
1 point(s)

A patient attends the ED with an apparent dislocated temporomandibular joint (TMJ). Which of the following statements correctly describes the presentation of TMJ dislocation to the ED?

Dislocation of the TMJ is a frequent presentation to the ED
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The TMJ can dislocate in an anterior, posterior, medial and lateral direction
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Anterior TMJ dislocation is commonly accompanied by fracture of the mandible
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The TMJ contains a cartilage which stabilises and reduces the range of movement of the joint
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Most TMJ dislocations are unilateral
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Question 3 of 10

3. Question
1 point(s)

When taking a history from a patient who has sustained a traumatic mandibular problem, which one of the following statements is correct?

A downward blow to a partially open mouth is a typical traumatic cause of anterior TMJ dislocation
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A fall onto the point of the chin typically fractures the body of the mandible
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Loss of consciousness rarely occurs in mandibular fracture
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Patients with a connective tissue disorder are less likely to dislocate their TMJ, due to a greater range and freedom of joint movement
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A lateral blow, usually as a result of interpersonal violence, typically causes fracture of the mandibular condyle
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Question 4 of 10

4. Question
1 point(s)

Upon examining the patient and inspecting the face and mandible, which one of the following statements is true?

A closed mouth, which the patient is unable to open, is found in a dislocated TMJ
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Bleeding from the ear is only due to a basal skull fracture or ruptured tympanic membrane
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Lacerations to the gum mucosa are common and do not correlate with the presence of a fracture
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A tilted or asymmetrical appearance of the mouth is pathognomonic of displaced mandibular fracture
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Haematoma in the sublingual space is indicative of mandibular fracture
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Question 5 of 10

5. Question
1 point(s)

Following your examination, you move on to feel and move the mandible. One of these statements regarding further examination is true â€“ which one is it?

Checking sensation over the upper lip and cheek is important as the mental nerve may be damaged in mandibular injury
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Insertion of a gloved finger in the external auditory meatus enables palpation of the coronoid process of the mandible
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Zygomatic arch fracture may limit movement of the mandible
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The tongue blade test is clinically useless in practice
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The commonest cause of a patient complaining that their teeth don’t fit 'correctly' is a tooth fracture or avulsion
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Question 6 of 10

6. Question
1 point(s)

Having examined your patient with mandibular trauma, your next decision is whether an x-ray is necessary. Which one of the following statements is true regarding this decision?

Use of a decision rule is limited by its ability to reduce the number of x-rays taken by 5 %
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The presence of blood in the mouth is a useful indicator in the decision to x-ray
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A 100 % sensitive decision rule has been developed for mandibular injury
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Malocclusion is not a useful discriminator in deciding whether an x-ray is needed
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It has been demonstrated that clinicians have greater diagnostic accuracy than a decision rule
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Question 7 of 10

7. Question
1 point(s)

You make a decision to order an x-ray on your patient. Which one of the following statements regarding x-ray ordering is correct?

An orthopantomogram (OPG) and standard mandibular series are equally accurate in detecting a mandibular fracture
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A chest x-ray should be ordered on all patients who have lost a tooth which cannot be accounted for
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Temporomandibular joint views are best for identifying a TMJ dislocation
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In an unconscious patient with a head injury, CT scan of the mandible is inaccurate and standard x-rays must be taken to exclude a fracture
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The addition of an AP mandible view to an OPG increases the accuracy of fracture detection
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Question 8 of 10

8. Question
1 point(s)

You diagnose a mandibular fracture in a 35 year old man who has attended the ED following an alleged assault. Which one of the following statements is true regarding his management?

A bilateral mandibular body fracture is a potential airway problem as anterior tongue support may be lost
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Most patients with mandibular fracture can be discharged with follow up arranged in the maxillofacial outpatients clinic two weeks later
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Antibiotics are not indicated in patients with fractures of the mandible
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All patients with a flail fracture of the mandible must have the fracture reduced immediately by pulling it forwards
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The location of the fracture is immaterial in the decision how to manage it, as all mandibular fractures are internally fixed
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Question 9 of 10

9. Question
1 point(s)

A 65-year-old woman presents to the ED with a clinically bilaterally dislocated TMJ. Which one of the following statements is correct regarding her presentation and management?

The most likely cause for the dislocation is that she has fallen onto her chin
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Reduction of the dislocation is made difficult by spasm of the digastric muscles
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The dislocation must be reduced by placing the operator’s fingers in the mouth
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The operator must protect themselves against a human bite when reducing the dislocation
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A medial dislocation can be reduced in the ED by a modification of the anterior dislocation technique
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Question 10 of 10

10. Question
1 point(s)

You successfully reduced your patient’s TMJ dislocation. Which one of the following statements is true regarding the post reduction management of your patient?

Having been given appropriate advice, the patient can be discharged to their GP with no need for follow up
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A Barton bandage is an important adjunct in stabilising the TMJ after reduction and should be applied to all patients
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The patient can be allowed to eat a normal diet as long as they don’t open their mouth wide
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Advice to the patient should include supporting the mandible with the hand when yawning and laughing
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Post reduction x-rays are unnecessary
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5 Comments

Andrew Smith June 19, 2019 at 1:02 pm

Very informative module

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Dr Kirsty Joanna Wilde February 16, 2022 at 4:22 pm

very helpful

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Dr Smita Tyagi May 9, 2022 at 3:34 pm

Very good module

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Dr Kelly Lewis September 9, 2022 at 7:10 pm

useful

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Dr Lucky Osakue Idemudia March 21, 2026 at 7:57 am

Nice revision

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