An orthopantomogram (OPG) is a good view to demonstrate most mandibular fractures.
A PA mandible shows the displacement of fractures. It also demonstrates symphysis menti fractures, which can be missed on the OPG.
A lateral view can be helpful if an OPG cannot be obtained. The body and ramus can be viewed along with the TMJ articulation.
Know your anatomy
Follow the line of the mandible.
Remember that the air-filled oesophagus often means that black lines cross the mandible near the angle of the mandible (see image above).
Look at the condylar and coronoid process, rami and body, submental symphysis, and alveolar ridge
Condylar process fractures can occur at the base so look carefully as they are easily missed.
In general, if you see one mandibular fracture, look for another one as it is common to have more than one, or TMJ dislocation.
A Guardsman’s fracture is where there is a fracture of the symphysis and both condyles. This is due to a fall with an impact on the midpoint of the chin.
Management
– Favourable fractures are held in alignment.
– Unfavourable fractures are displaced by the muscles pulling them.
– Mandibular fractures of the body or angle of the mandible can be managed conservatively unless they are displaced, in which case reduction and internal fixation may be required.
– Condylar fractures are usually managed conservatively unless there is occlusion of normal movement due to dislocation of the condylar head.
