Special Tests

The image shows the tongue blade test. It has been described and mainly utilised in the United States as an aid to the diagnosis of a mandibular fracture.

In this examination, a wooden spatula is held between the patient’s teeth on each side of the mandible and the examiner applies a twisting force; in some descriptions, a force large enough to break the blade. A positive test is one where the patient is unable to hold the blade whilst pressure is applied.

A BestBets review of the test concluded it may be useful in ruling out a fracture, as the combined sensitivity was 95%, although confidence intervals were wide [7]. The tongue blade test should therefore be used in combination with other clinical findings.

Learning Bite

The tongue blade test is useful in ruling out a mandibular fracture when combined with other clinical findings.