History

All facial injuries, including mandibular fractures, are commonly associated with injury elsewhere [1], particularly to the head and neck. Also, certain mandibular injuries may compromise the airway needing urgent attention. Any assessment must therefore start by following standard ATLS principles.

The mechanism of injury may point towards the site of injury:

• In children, a fall onto the point of the chin may fracture the mandibular condyle(s)
• A lateral blow, common in interpersonal violence, is associated with a mandibular body or ramus fracture
• A downward blow to the partially opened mouth may dislocate the TMJ

Almost one in five mandibular fractures are associated with a witnessed loss of consciousness [5].

Learning Bite

Head injury commonly accompanies mandibular fracture and must be separately assessed and investigated.

If a TMJ dislocation is suspected, find out about prior TMJ symptoms, including previous dislocations or presence of a connective tissue disorder.