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Mandibular Fracture: Causes, Symptoms & Treatment

A mandibular fracture is a break in the lower jawbone (mandible). It most commonly results from trauma and typically requires medical or surgical treatment.

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A mandibular fracture is a break in the lower jawbone (mandible). It most commonly results from trauma and typically requires medical or surgical treatment.

What is a Mandibular Fracture?

A mandibular fracture is a break in the mandible, the lower jawbone and the only movable bone of the facial skeleton. The mandible is a horseshoe-shaped bone that supports the lower teeth and connects to the skull via the temporomandibular joint (TMJ). Mandibular fractures are among the most common facial bone injuries and require thorough medical evaluation and appropriate treatment.

Causes

Mandibular fractures are most often caused by external force or trauma. The most common causes include:

Motor vehicle accidents (cars, motorcycles, bicycles)
Falls, especially in elderly individuals or during sports activities
Physical assaults (direct blows to the jaw)
Sports injuries (e.g., combat sports, football, ice hockey)
Occupational accidents involving direct impact to the lower face
Pathological fractures: In rare cases, pre-existing conditions such as tumors, cysts, or advanced osteoporosis can weaken the bone to the point where minimal force causes a fracture.

Classification and Common Fracture Sites

Mandibular fractures are classified according to their location on the bone. Common fracture sites include:

Parasymphysis (lateral to the midline, very common)
Condyle: fracture at or near the temporomandibular joint
Angle (angulus mandibulae): often associated with impacted wisdom teeth
Symphysis (midline of the lower jaw)
Ramus (vertical branch of the mandible)
Coronoid process (less common)

Fractures may be simple (single fracture line) or multiple. High-energy trauma often results in comminuted fractures with multiple fragments.

Symptoms

Typical signs and symptoms of a mandibular fracture include:

Pain in the jaw area, worsened by chewing or opening the mouth
Swelling and bruising (hematoma) over the jaw or chin
Limited mouth opening or complete inability to open the mouth (trismus)
Malocclusion: the teeth no longer meet properly when biting
Numbness or tingling of the chin or lower lip (due to involvement of the inferior alveolar nerve)
Abnormal mobility of jaw segments or a palpable step deformity along the bone
Bleeding from the mouth or from an open wound
Difficulty speaking or swallowing

Diagnosis

Diagnosis is established through clinical examination and imaging:

Physical examination: palpation for tenderness, step deformity, and abnormal mobility; assessment of occlusion and mouth opening
Orthopantomogram (OPG): panoramic X-ray of the entire jaw – often the first imaging method used
Computed tomography (CT): particularly valuable for complex, multiple, or condylar fractures; today considered the gold standard in trauma imaging
3D CT reconstruction: enables precise surgical planning

Treatment

Treatment depends on the severity, location, and type of fracture, as well as the overall health of the patient.

Conservative Treatment

For non-displaced fractures without functional impairment, conservative management may be sufficient:

Soft or liquid diet to reduce strain on the jaw
Pain relievers and anti-inflammatory medications
Intermaxillary fixation (IMF): wiring or banding the upper and lower jaw together for several weeks to immobilize the fracture

Surgical Treatment

For displaced, unstable, or open fractures, surgery is usually required:

Open reduction and internal fixation (ORIF): surgical realignment of bone fragments and fixation using titanium plates and screws
Miniplate osteosynthesis: the standard procedure in oral and maxillofacial surgery
Condylar fractures may be managed conservatively or surgically, depending on severity and displacement

Follow-up and Rehabilitation

Regular follow-up examinations are essential after treatment. Physiotherapy and targeted jaw exercises help restore full function. Healing time is typically 4 to 8 weeks, and may be longer for complex fractures.

Possible Complications

Malunion resulting in permanent malocclusion
Infection (particularly in open fractures or fractures involving teeth)
Permanent nerve damage with lasting numbness
Temporomandibular joint problems following condylar fractures
Restricted mouth opening (trismus)

References

Neff A et al.: S2k guideline: Fractures of the mandible. German Society of Oral and Maxillofacial Surgery (DGMKG), 2017. Available at: www.awmf.org
Ogundare BO, Bonnick A, Boulis NM: Mandibular fracture epidemiology. J Oral Maxillofac Surg. 2003;61(9):1037–1042. PubMed PMID: 12966483.
Ellis E 3rd: Outcomes of patients with teeth in the line of mandibular angle fractures treated with stable internal fixation. J Oral Maxillofac Surg. 2002;60(8):863–865. PubMed PMID: 12149726.

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