Exodontia.Info
Fractures of the Mandible /
Lower Jaw
Fractures of the Mandible / Lower Jaw

This leaflet has been designed to improve your
understanding of your forthcoming treatment and contains
answers to many of the common questions.  If you have any
other questions that the leaflet does not answer or would
like further explanation please ask a member of the medical
or nursing staff.

The problem

Your lower jaw has been broken.

The number of
fractures, where they have occurred and
whether they need treatment to help them heal has already
been established by the doctor who examined you.

What does the operation involve?

The treatment involves a general anaesthetic, which means
you are going to be put to sleep completely.

Once you are asleep, we will make a cut on the inside of
your mouth through the gum.

The broken bones are then put back together and held in
place with small metal plates and screws.

The gum is stitched back into place with dissolvable
stitches, which can take a fortnight or even longer to fall out.

Sometimes, it is necessary to
place wires, metal braces or
orthodontic brackets around / on your teeth so that elastic
bands can be attached to them.  Screws inserted into the
jawbone above the teeth are occasionally used instead of
these wires or metal braces.

Any elastic bands are not usually attached until the day
after your operation, which means that your jaws will be
able to move freely when you wake up from surgery.  The
bands will guide your bite into the correct position after
surgery.
Will anything else be done while I am asleep?

Occasionally, it is necessary to remove damaged or
decayed teeth at the site of the fracture.  In very difficult
fractures, it is sometimes necessary to make a cut on the
outside of the mouth through the skin.  If this is going to
take place, the site and size of the cut will be discussed
with you before you sign any consent form for your
operation.

What can I expect after the operation?

  • It is likely to be sore and regular painkillers will be
    given to you by the hospital doctor.  The discomfort is
    usually worse for the first few days although it may
    take a couple of weeks to completely disappear.

  • You will also be given antibiotics through a vein in your
    arm whilst you are in hospital to fight infection.

  • You will be sent home with painkillers and a course of
    antibiotics.

  • You usually stay in hospital for one night following the
    surgery.  The following day, the position of your
    fractures will be checked with X-rays before you are
    allowed home.

  • Although the plates and screws hold the fractures in
    place it still takes around six weeks for your lower jaw
    to heal completely.  During this time you need to eat a
    relatively soft diet.  This will be discussed with you by
    the doctors, nurses and dieticians.

  • It is also important that you keep your mouth as clean
    as possible for the first few weeks after surgery to
    prevent infection.  It may be difficult to clean your teeth
    around stitches because it is sore.  It is best to keep
    the area free from food debris by gently rinsing your
    mouth with a mouthwash or warm salt water (dissolve
    a flat teaspoon of kitchen salt in a cup of warm water)
    starting on the day after surgery.


Do I need to take any time off work?

Depending on the nature of your work you may need to
take a fortnight or so off work.  Avoid strenuous exercise
for this time.  It is important to remember that you should
not drive or operate machinery for 48 hours after your
general anaesthetic.

What are the possible problems?

  • Infections are uncommon because of the antibiotics
    that are used.

  • Bleeding from the cuts inside your mouth is unlikely to
    be a problem.  However, should the area bleed when
    you get home apply pressure over the site for at least
    10 minutes with a rolled up handkerchief or swab.

  • Numbness of the Lower Lip & Tongue.  The Inferior
    Dental Nerve that runs through the centre of the lower
    jaw that supplies feeling to your lower lip, chin and the
    lower teeth.  This nerve may have been bruised at the
    time of the fracture and as a result you might already
    feel some tingling or numbness in your lip and/or chin.

    This tingling may also be caused/made worse by
    surgery.  In the majority of people the numbness gets
    better on its own although it can take several months
    to do so (this usually lasts about 6 – 12 months, but
    may be permanent).

    The Lingual Nerve is on each side of the inside of the
    mandible (lower jaw).  This nerve passes very close to
    the tongue side of the fracture.  It gives feeling and
    taste to that side of the tongue.  This nerve may have
    been damaged in the injury.  Due to the closeness of
    this nerve to the area of surgery, there is a small
    possibility of some damage to the nerve.  Damage to
    this nerve causes that side of the tongue to go numb.  
    More rarely, it may cause irritating sensations as well
    as loss of taste on that side of the tongue.  Although
    this effect is usually temporary (6 – 12 months) it may
    be permanent.

  • Damage to Teeth in Fracture Zone.  Occasionally,
    teeth next to the fracture site may be damaged by
    screws that are used to hold the titanium plates in
    place or to bring the jaws together with wires.  As a
    consequence, these teeth may die and require dental
    treatment to keep them.

  • Plate Removal.  If it has been necessary to put any
    plates or screws in your jaw to hold it in position, these
    are not normally removed unless they get infected
    because they tend not to cause problems.  The metal
    that is used is titanium which does not set off metal
    detectors in airports etc.

  • Delayed Union of the fractured jaw bone occur in
    approximately 3% of fractures.  Delayed union is a
    temporary condition in which adequate reduction of the
    broken jaw and limitation of movement of the broken
    jaw eventually produces bony union (that is, it heals).

  • Mal-Alignment / Mal-Union.  In a few cases, the
    fracture may not heal after repair and further
    operations may be needed.  The fracture may not be
    able to be precisely put back together.  This may result
    in some change in the bite.  Not all mal-unions are
    clinically significant.

  • Non-Union.  Sometimes, the fracture just doesn’t heal.  
    This can often be due to infection or impaired healing
    due to the patient’s medical condition.  This may need
    further surgery to correct the non-union of the fracture.

  • Facial Weakness.  Sometimes, in order to get good
    access to repair the broken jaw, we have to go
    through the cheek.  The nerve making the facial
    muscles move (the Facial Nerve) may be traumatized
    as a result.  This can lead to a drooping at the side of
    the mouth.  This improves with time.  Also, there may
    be some scarring at this site.  This will be small and
    not particularly noticeable.

  • Limitation of Mouth Opening.  This should improve
    with time.  However, to begin with, you may find you
    have to stick to a soft/liquidized diet.

  • Need for ‘Fine Tuning’ of the Bite.  Even though we will
    try to restore the way you bite together to its original
    state, there is sometimes the need to ‘fine tune’ the
    way you bite together.  This involves grinding spots on
    the biting surface of the teeth.


Will I need further appointments?

A review appointment will be arranged before you leave
hospital. We will keep a close eye on you for several
months following treatment to make sure that your jaw
heals uneventfully.
Last Updated 11th August 2010