If in A+E what should do first?
Check patient has been cleared for c-spine injuries/ neurological issues
Where can mandible fracture?
Condyle, angle, symphysis,
body
What most common cause mandibular #
Sports injury, interpersonal violence, RTAs
What is common presentation?
Pain, swelling, deformity, malocclusion, loss of sensation, fractured teeth
How would patient with guardsman # present?
AOB
Where is broken in guardsman #
Bilateral condyle and symphysis
Mx of guardsman #?
Fixation of both condyles and symphysis
If communicated may need intermaxillary fixation
What special investigations if suspect #?
OPT and PA mandible - need two views at different angles to view #
What to do if pt is unconscious or very complication?
Request CT scan
How prepare pt for GA?
- When did last eat - keep NMB
- Consent for GA
- IV fluids/ antivioitcs
How take consent for GA #?
Pain, swelling, bleeding, bruising, infection, stitches both EO and IO, scarring, further malocclusion, potential loss of teeth
How arrange GA?
- Prepare the patient
- Inform senior members of staff
- Inform anaesthesia - will need to reviewed prior to GA
- Book theatre - CPOD
What is most common management of mandibular #
Open reduction and internal fixation
What is step -step algorithm for mx of #?
- Check been cleared from trauma team
- Full hx and examination
- Confirm MH
- Differential dx of #
- Special investigations - OPG/ PA mandible
- Blood tests - FBC/ U+E/ CRP
- Prescribe analgesia, antibioitcs and fluids
- Keep pt NMB
- Present to seniostaff
- Consent patient to GA
- Informed CEPOD / anaesthesia for review
- GA - ORIF +- IMF
- Post-op care
What analgesia would give?
1g QDS IV paracetamol
First line ab for #?
Co-amoxiclav - 1.2g IV (check penicillin)
What fluids would give?
Saline/ Hartmanns
Post-op care?
Analgesia
No contact sport
Soft diet
Review
