Jaw - broken or dislocated

Definition

Your jaw bone contains your lower teeth. This is the bone that moves up and down when you chew. When injured, it can break or move out of position.

Considerations

A broken or dislocated jaw usually heals completely after treatment. However, the jaw may become dislocated again in the future.

Complications may include:

• Airway blockage
• Bleeding
• Breathing blood or food into the lungs
• Infection of the jaw or face
• Recurrent dislocated jaw
• Jaw joint (TMJ ) pain and other problems
• Difficulty talking (temporary)
• Difficulty eating (temporary)
• Problems aligning the teeth

Causes

A broken or dislocated jaw is a common facial injury. The jaw (also called the mandible) is the only mobile bone of the face. It holds the lower teeth. The term "upper jaw" refers to the immobile bone that extends from the upper teeth to the eyes.

The jaw is connected to the skull by a hinged joint located in front of the ears (temporomandibular joint). Strong muscles extend from the jaw to the skull.

A dislocated jaw occurs when the mandible is displaced from one or both of the temporomandibular joints. Fractures (breaks) in the jaw bone may occur at the site of injury and on the opposite side of the jaw. If the upper jaw bone is also fractured, the trauma may have been severe enough to involve multiple areas of the face, neck, and back.

The most common cause of a broken or dislocated jaw is a traumatic blow to the face. This may be the result of a motor vehicle accident, industrial accident, recreational or sports injury, assault, or other trauma.

Symptoms

Symptoms of a dislocated jaw include:

• Pain in the face or jaw, located in front of the ear on the affected side, worse with movement
• Inability to close the mouth
• Drooling because of inability to close the mouth
• Difficulty speaking
• Jaw may protrude forward
• Teeth may not align normally
• Bite feels "off" or crooked

Symptoms of a fractured (broken) jaw include:

• Jaw tenderness or pain, worse with biting or chewing
• Jaw stiffness
• Difficulty opening the mouth widely
• Severe fracture limiting any movement of the jaw
• Lump or abnormal appearance of the cheek or jaw
• Numbness of the face (particularly the lower lip)
• Facial swelling
• Facial bruising
• Loose or damaged teeth
• Bleeding from the mouth

First Aid

A broken or dislocated jaw is an acute condition that requires prompt examination by a health care provider because of the risk of breathing difficulty or profuse bleeding. A tube inserted into the airway (endotracheal tube) may be needed if the patient is having trouble breathing or bleeding profusely, or if facial swelling is severe and breathing difficulty is likely to develop.

The jaw should be supported during transportation to the emergency room. This is most easily accomplished by holding the jaw gently in the hands. A bandage may also be wrapped over the top of the head and under the jaw, but the bandage should be easily removable in case the victim needs to vomit.

DISLOCATED JAW

The goal of treatment is proper positioning of the jaw's hinged ball (condyle) within the TMJ.

The health care provider may be able to manually replace the condyle into the TMJ. The thumbs are placed behind the back teeth on both sides of the mouth and the mandible is pressed downward firmly and steadily until it "pops" back into place.

Anesthetics (local or general) may be required to allow the strong jaw muscles to relax enough for manipulation of the jaw.

Stabilization of the joint may be required. This usually involves bandaging the jaw to keep the mouth from opening widely.

Surgical stabilization of the joint may be required, particularly if repeated jaw dislocations occur.

The mouth should not be opened widely for at least 6 weeks after dislocation. The jaw should be supported by one or both hands during motions such as yawning and sneezing to prevent excessive strain on the temporomandibular joint.

FRACTURED JAW

The goal of treatment is proper alignment of the jaw bone so the upper and lower teeth come together normally.

Temporary immobilization of the bone by bandaging the jaw (around the top of the head) or immobilizing the jaw with the hands may reduce pain.

If the fracture is minor, no treatment may be required other than analgesics for discomfort and a soft (or liquid) diet to minimize pain while chewing.

Surgery is often required for moderate to severe fractures to align and immobilize the bone so it can heal.

The jaw may be wired to the teeth of the opposite jaw to improve stability. Jaw wires are usually left in place for 6 to 8 weeks. The wires are used to hold metal bands with small blunt hooks (archbars) to the teeth. Small rubber bands (elastics) are used to hold the teeth together. After a few weeks of complete immobilization of the jaw, some of the elastics are removed to allow motion and reduce stiffness of the TMJ.

If the jaw is wired, only liquid or very soft foods can be eaten. Blunt scissors should be available to cut the elastics, so that -- if the person vomits or chokes -- the jaw can be opened to prevent aspiration into the lungs. If the wires must be cut, consult the health care provider promptly so they can be replaced.

Do Not

• DO NOT attempt to relocate the jaw.
• DO NOT move a person with a dislocated jaw unless he is in danger.

Call immediately for emergency medical assistance if

Call immediately if a broken or dislocated jaw may be present. Emergency symptoms include difficulty breathing or profuse bleeding after a facial injury.

Prevention

Safe practices in work, sports, and recreation -- wearing a proper helmet when playing football -- may prevent some accidental injuries to the face or jaw.

Illustrations

Mandibular fracture

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