Jaw Injuries: Causes, Symptoms and Treatment

What Are Jaw Injuries?

Jaw injuries refer to traumatic damage affecting the bony or soft tissue structures of the jaw, including the upper jaw (maxilla) and the lower jaw (mandible). These injuries range from mild contusions and sprains to severe fractures and may involve surrounding facial structures such as the teeth, gums, temporomandibular joint, and facial nerves.

Causes

Common causes of jaw injuries include:

• Motor vehicle accidents (e.g., impact with steering wheel or dashboard)
• Falls, especially in elderly individuals or during sports activities
• Physical assaults or fights
• Sports injuries (e.g., contact sports, martial arts, cycling)
• Workplace accidents involving mechanical force

Types of Jaw Injuries

Mandibular Fractures

Mandibular fractures are the most common type of jaw fracture. They most frequently occur at the angle of the jaw, along the body of the mandible, or at the condyles (the rounded ends that form part of the jaw joint). Patients typically experience pain when chewing, a changed bite alignment, and visible or palpable deformity.

Maxillary Fractures

Upper jaw fractures are commonly classified using the Le Fort classification system (Le Fort I, II, III), which describes different fracture patterns of the mid-face. These injuries usually result from high-energy trauma and may involve the orbit, sinuses, or skull base.

Temporomandibular Joint Injuries

Injuries to the temporomandibular joint (TMJ) can include contusions, subluxations (partial dislocations), or fractures of the condylar process. Symptoms include jaw stiffness, clicking or popping sounds, and restricted mouth opening.

Soft Tissue Injuries

In addition to bony injuries, soft tissues including the lips, tongue, cheeks, and gums are frequently affected. Lacerations, bruising, and bite wounds are common accompanying injuries.

Symptoms

Typical signs and symptoms of jaw injuries include:

• Pain in the jaw or facial area, especially when chewing or speaking
• Swelling and bruising (hematoma) of the face
• Misalignment of the teeth or an altered bite
• Limited or painful mouth opening
• Numbness in the face (indicating possible nerve involvement)
• Visible deformity or a step-like irregularity along the jaw
• Tooth loss or loosened teeth
• Bleeding from the mouth or nose

Diagnosis

Diagnosis of jaw injuries typically involves:

• Clinical examination: Palpation of the jaw, assessment of mouth opening and occlusion (bite)
• X-rays: Panoramic radiograph (OPG) for an overall view of the jaw and teeth
• Computed tomography (CT): For detailed imaging of complex fractures, particularly in the mid-face or involving the skull base
• Magnetic resonance imaging (MRI): When soft tissue or TMJ injuries are suspected

Treatment

Conservative Treatment

Non-displaced or minimally displaced fractures and contusions may be managed conservatively. Options include intermaxillary fixation (wiring the jaws together to immobilize the fracture), pain management, and a soft or liquid diet for several weeks until healing is complete.

Surgical Treatment

Displaced or unstable fractures often require surgical intervention. The bone fragments are repositioned and stabilized using titanium plates and screws (open reduction and internal fixation / ORIF). This procedure is typically performed by oral and maxillofacial surgeons.

Dental Care

Associated dental injuries such as tooth fractures or avulsed (knocked-out) teeth require prompt treatment by a dentist or oral surgeon. A knocked-out tooth should be stored in a tooth preservation solution and emergency dental care sought immediately.

Rehabilitation

Following acute treatment, physiotherapy to restore jaw mobility, speech therapy for any swallowing or speech difficulties, and orthodontic follow-up may all be necessary components of recovery.

When to Seek Medical Attention

Medical attention should be sought immediately in cases of:

• Severe pain or visible deformity of the jaw
• Restricted mouth opening
• Numbness or loss of sensation in the face
• Tooth loss following trauma
• Associated head or neck injuries

References

1. Rowe, N.L., Williams, J.L. (Eds.) - Maxillofacial Injuries. Churchill Livingstone, Edinburgh, 2nd edition.
2. Neff, A. et al. - Management of Mandibular Fractures. In: Oral and Maxillofacial Surgery, 2020.
3. Kellman, R.M. - Maxillofacial Trauma. In: Cummings Otolaryngology: Head and Neck Surgery, 7th edition, Elsevier, 2021.