Bilateral mandibular fracture after a road traffic collision
24-year-old male
§Chief complaint
Painful jaw, cannot bite properly after a motorcycle crash
§Medical & dental history
- 01No comorbidity
- 02Not on anticoagulants
- 03Tetanus immunisation up to date
- 04Full dentition, 38 and 48 present
§Clinical examination
- 01Step deformity at the left parasymphysis, anterior open bite
- 02Sublingual haematoma — pathognomonic of mandibular fracture
- 03Paraesthesia of the right lower lip
- 04Trismus 18 mm, bleeding from the gingiva at 33/34
§ figuresFigures (2)
Fig. 1Fractured jaw
“Jaw Radiograph” · Rtstudents · CC BY-SA 3.0 · Wikimedia Commons
Fig. 2occlusal radiograph of a mandibular parasymphasis fracture
“Occlusal view symphsis fracture” · Coronation Dental Specialty Group [1] · CC BY 3.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Mandibular Fracture figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Left parasymphyseal and right subcondylar fracture of the mandible
Mandibular fractures are commonly bilateral: a direct blow at one site produces an indirect contralateral condylar or angle fracture. Sublingual haematoma plus derangement of occlusion localises the fracture even before imaging.
§Investigations
- 01OPG and PA mandible — parasymphyseal fracture with displacement, right subcondylar fracture
- 02CT face with 3D reconstruction
- 03Cervical spine clearance, ATLS primary survey
- 04Pre-anaesthetic bloods
§Treatment plan
- 01ATLS assessment and airway protection
- 02Antibiotics and analgesia; fracture is compound into the mouth
- 03ORIF of the parasymphysis; closed reduction with MMF for the subcondylar fracture
- 04Soft diet and physiotherapy
§Surgical procedure
- 01Arch bars applied and intermaxillary fixation to establish occlusion
- 02Intraoral vestibular approach to parasymphysis, two 2.0 mm miniplates per Champy principles
- 03Elastic guidance for the condyle for 2 weeks
§Follow-up & outcome
- 01Occlusion restored at 6 weeks, elastics discontinued
- 02Lip paraesthesia improving by 3 months
- 03Mouth opening 40 mm at 3 months with physiotherapy
§Clinical pearls / learning points
- 01Always look for a second fracture — the mandible is a ring.
- 02Sublingual haematoma is nearly pathognomonic of a mandibular body fracture.
- 03Restoring the pre-injury occlusion, not radiographic perfection, is the goal.
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L3 · Systematic review — 1
- L6 · Textbook — 5
2 linked sources were published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Systematic Reviews & Meta-Analyses
Rashid S, Kumar RD, Kalimuddin KS. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery · 2026 · 54(7):104560
Systematic review comparing closed treatment with open reduction and internal fixation for condylar head fractures.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Hupp JR, Ellis E, Tucker MR. Elsevier · 2019
Core surgical textbook covering exodontia, infection, trauma and preprosthetic surgery.
Ehrenfeld M, Manson PN, Prein J. Thieme / AO Foundation · 2012
Reference standard for craniomaxillofacial trauma osteosynthesis principles and techniques.
Additional sources cited on this page
- Ehrenfeld M, Manson P, Prein J. Principles of Internal Fixation of the Craniomaxillofacial Skeleton.
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