A broken or dislocated jaw is an acute condition that requires prompt examination by a health care provider because of the risk of breathing difficulty or profuse bleeding. A tube may need to be inserted into the airway (endotracheal tube) if the patient is having trouble breathing or bleeding profusely, or if facial swelling is severe and breathing difficulty is likely to develop.
The jaw should be supported during transportation to the emergency room. This is most easily accomplished by holding the jaw gently in the hands. A bandage may also be wrapped over the top of the head and under the jaw, but the bandage should be easily removable in case the victim needs to vomit.
DISLOCATED JAW
The goal of treatment is proper positioning of the jaw's hinged ball (condyle) within the temporal-mandibular joint (TMJ).
The health-care provider may be able to manually replace the condyle into the TMJ. The thumbs are placed behind the back teeth on both sides of the mouth and the mandible is pressed downward firmly and steadily until it "pops" back into place.
Anesthetics (local or general) may be required to allow the strong jaw muscles to relax enough for manipulation of the jaw.
Stabilization of the joint may be required. This usually involves bandaging the jaw to keep the mouth from opening widely.
Surgical stabilization of the joint may be required, particularly if repeated jaw dislocations occur.
The mouth should not be opened widely for at least 6 weeks after dislocation. The jaw should be supported by one or both hands during motions such as yawning and sneezing to prevent excessive strain on the temporal-mandibular joint.
FRACTURED JAW
The goal of treatment is proper alignment of the jaw bone so the upper and lower teeth come together normally.
Temporary immobilization of the bone by bandaging the jaw (around the top of the head) or immobilizing the jaw with the hands may reduce pain.
If the fracture is minor, no treatment may be required other than analgesics for discomfort and a soft (or liquid) diet to minimize pain while chewing.
Surgery is often required for moderate to severe fractures to align and immobilize the bone so it can heal.
The jaw may be wired to the teeth of the opposite jaw to improve stability. Jaw wires are usually left in place for 6 to 8 weeks. The wires are used to hold metal bands with small blunt hooks (archbars) to the teeth. Small rubber bands (elastics) are used to hold the teeth together. After a few weeks of complete immobilization of the jaw, some of the elastics are removed to allow motion and reduce stiffness of the TMJ.
If the jaw is wired, only liquid or very soft foods can be eaten. Blunt scissors should be available to cut the elastics, so if the person vomits or chokes the jaw can be opened to prevent aspiration into the lungs. If the wires must be cut, consult the health care provider promptly so they can be replaced.
