by terry zeigler, edd, atc
A broken jaw (mandibular fracture) is the second most common facial fracture in sports due to its anterior location in the skull. the mandible is the jaw. Because the jaw is exposed and not covered by most protective devices, it is susceptible to injury.
symptoms of jaw fracture
The mandible is usually fractured in more than one place and occurs on opposite sides of the midline of the mandible. These fractures can be displaced (more severe with separated and separated bone ends) or non-displaced (aligned bone ends).
Signs and symptoms of a displaced jaw fracture include:
• severe deformity • malocclusion (teeth do not align when the jaw is closed) • oral bleeding • paresthesia or anesthesia of the lower lip and chin • speech changes • swelling • bruising on the floor of the mouth • laceration of the mucous membrane
Signs and symptoms of a nondisplaced mandible fracture include:
• oral bleeding that oozes between the teeth • pinpoint tenderness over the fracture site • pain when opening and closing the jaw • swelling • discoloration
who breaks their jaw?
Mandible fracture is usually caused by hitting the lower jaw with sports equipment (hockey stick, bat). Due to the length of a hockey stick and/or bat, it doesn’t take as much force from the opponent swinging the equipment to create enough force to fracture the jaw.
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 on the lower jaw or chin hitting a hard surface.
fighting sports where direct blows are taken as part of the sport (boxing, mixed martial arts) also have a high incidence of jaw fractures.
treatment for jaw fracture
If a jaw fracture is suspected, emergency services should be called immediately. Initial treatment should focus on maintaining an open airway with the athlete in a seated position with the athlete’s hands supporting the lower jaw. this position will allow blood to flow forward and out of the mouth instead of back into the throat.
Because the amount of force required to fracture the jaw is significant, care should be taken to assess the athlete for possible concussion and/or brain injury as well.
To determine if the athlete has signs and symptoms of concussion, check the following:
• dizziness • headache • confusion • nausea • ringing in the ears • inability to answer simple questions
If any of the above symptoms are present, assume the athlete may also have a concussion. An unconscious athlete or an athlete with a suspected concussion should be placed on their side with their head tilted and jaw supported after the mouth has been cleaned of any broken or displaced teeth.
The mandible can be immobilized with an ace bandage or rolling gauze, but care must be taken to ensure that the mandible is not displaced posteriorly, which may compromise the airway. bandages can be wrapped under the chin and over the top of the head.
A bag of crushed ice may 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 mandible fracture, 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 the treating physician recommends.
Most displaced mandible fractures will require closed reduction and internal fixation for four to six weeks. while the athlete’s jaw is wired shut, the athlete must consume high-protein, high-carbohydrate liquid diets. it is normal for an athlete to lose between 5% and 10% of his body weight during this time. if there is concern about the amount of weight lost, the athlete should consult with a nutritionist.
return to sports after a jaw fracture
Light activities such as stationary cycling, walking, and light resistance exercises can be performed during the fixation time to maintain muscle tone. care must be taken not to increase the heart rate to a level where more oxygen is needed for the muscles because the athlete can only breathe through the nose and cannot breathe through the mouth to increase oxygen consumption. it is recommended that the athlete not return to contact or collision sports until one to two months after the jaw wires are removed.
references
- anderson, m.k., hall, s.j., & martin, m. (2009). fundamentals of athletic training: prevention, evaluation and management. (3rd ed.). lippincott williams & wilkins: philadelphia, pa
- bahr, r., & maehlum s. (2004). Sports injury clinical guide. human kinetics: champaign, il.
- brukner, p., & khan, k. (2004). Clinical sports medicine (2nd revised ed.). mcgraw hill: new york, ny.