Management of Mandibular Fracture

Specific management of mandibular fractures is complex and it is therefore recommended that all patients are discussed with a maxillofacial surgeon. Factors which will influence the further management include:

• Presence of other injuries
• Location and orientation of the fracture
• Open fractures
• Potential for airway compromise

With bilateral mandibular body fractures (a flail segment) anterior tongue support is lost, resulting in posterior displacement of the tongue which occludes the airway.

In this situation, the patient’s airway must be protected by intubation, as soon as possible. As a temporary measure, ask the patient to lean forward or place them in the recovery position. If this is not possible due to other injuries, the flail segment should be grasped and pulled anteriorly, pulling the tongue forward and an oropharyngeal airway inserted.

Learning Bite

Flail fracture of the mandible may occlude the airway in an obtunded patient. It may require emergency manual reduction of the fracture to pull the tongue forwards, thereby clearing the airway.