Broken jaw (mandibular fracture)
A broken jaw (mandibular fracture) is the second most common facial fracture in sports because of the anterior location on the skull. The mandible is the jawbone. Because the mandible is exposed and not covered by most protective devices, it is susceptible to injury.
Symptoms of broken jaw
The mandible usually fractures in more than one place and occurs on opposite sides of the midline of the jaw. These fractures can either be displaced (more severe with bone ends separated and moved apart) or nondisplaced (bone ends aligned).
The signs and symptoms of a displaced broken jaw include:
• Gross deformity
• Malocclusion (teeth do not align when the jaw is closed)
• Oral bleeding
• Paresthesia or anesthesia of lower lip and chin
• Changes in speech
• Bruising to the floor of the mouth
• Mucous membrane tears
The signs and symptoms of a nondisplaced broken jaw include:
• Oral bleeding oozing between the teeth
• Point tenderness over the fracture site
• Pain on opening and closing the jaw
Who gets a broken jaw?
A broken jaw is most often caused by a blow to the lower jaw from sports equipment (hockey stick, bat). Because of the length of a hockey stick and/or bat, it does not take as much force from the opponent swinging the equipment to create enough force to fracture the jawbone.
Mountain biking is another sport with a high incidence of facial fractures. This type of injury occurs when the athlete goes over the handlebars and falls directly onto the lower jaw or chin hitting a hard surface.
Fighting sports in which direct blows are delivered as part of the sport (boxing, mixed martial arts) also have a high incidence of jawbone fractures.
Treatment for broken jaw
If a broken jaw is suspected, emergency services should immediately be called. Initial treatment should be focused on maintaining an open airway with the athlete in a sitting position with the athlete’s hands supporting the lower jaw. This position will allow the blood to flow forward and out of the mouth rather than back into the throat.
Because the amount of force required to fracture the mandible is significant, care must be taken to evaluate the athlete for a possible concussion and/or brain injury also.
To determine if the athlete has any signs and symptoms of concussion, check for the following:
• Ringing in the ears
• Inability to answer simple questions
If any of the above symptoms are present, assume that the athlete may also have a concussion. An unconscious athlete or an athlete with a suspected concussion should be placed on their side with a head tilt and jaw support after the mouth has been cleared of any broken or dislodged teeth.
The jaw can be immobilized using an ace bandage or roller gauze but care must be taken to ensure that the jaw is not displaced posteriorly which may compromise the airway. The bandages can be wrapped under the chin and over the top of the head.
A crushed ice pack can be applied to the area to reduce the amount of swelling. However, care must be taken that the weight of the ice pack does not displace the fracture.
Is surgery needed to repair a broken jaw?
If the athlete has sustained a nondisplaced jawbone fracture, the healing can be managed conservatively with analgesia and rest. To allow the fracture to heal properly, the athlete should only eat soft foods for up to four weeks or as long as recommended by the treating physician.
Most displaced jawbone fractures will require closed reduction and internal fixation for four to six weeks. While the athlete’s jaw is wired shut, the athlete should be consuming high-protein, high-carbohydrate liquid diets. It is normal for an athlete to lose between 5% and 10% of his/her body weight during this time. If there is concern about the amount of weight lost, the athlete should consult with a nutritionist.
Returning to sports after a broken jaw
Light activities such as stationary cycling, walking, and light resistance exercises can be performed during the time of fixation to maintain muscle tone. Care should be taken not to increase the heart rate to a level where increased oxygen is needed for the muscles because the athlete is only able to breathe through his/her nose and not able to breathe through his/her mouth to increase the oxygen uptake. It is recommended that the athlete should not return to contact or collision sports until one to two months after the jaw is unwired.
Getting a Second Opinion
A second opinion should be considered when deciding on a high-risk procedure like surgery or you want another opinion on your treatment options. It will also provide you with peace of mind. Multiple studies make a case for getting additional medical opinions.
In 2017, a Mayo Clinic study showed that 21% of patients who sought a second opinion left with a completely new diagnosis, and 66% were deemed partly correct, but refined or redefined by the second doctor.
You can ask your primary care doctor for another doctor to consider for a second opinion or ask your family and friends for suggestions. Another option is to use a Telemedicine Second Opinion service from a local health center or a Virtual Care Service.
SportsMD’s Second Opinion and Telehealth Service
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- Anderson, M.K., Hall, S.J., & Martin, M. (2009). Foundations of Athletic Training: Prevention, Assessment, and Management. (3rd Ed). Lippincott Williams & Wilkins: Philadelphia, PA
- Bahr, R., & Maehlum S. (2004). Clinical Guide to Sports Injuries. Human Kinetics: Champaign, IL.
- Brukner, P., & Khan, K. (2004). Clinical Sports Medicine (revised 2nd Ed.). McGraw Hill: New York, NY.