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ideal, they are alternative mediums that are preferred over water or worse
allowing the root surface to air dry ( Fig. 105.5 ). The patient should proceed
directly to the dentist for radiographs, final alignment, splinting, and close followup.

JAW FRACTURES
CLINICAL PEARLS AND PITFALLS
Trauma to the chin may result in a condylar fracture.
Because the jaw is a ring structure, identification of a single fracture
warrants careful examination for an accompanying injury.
Mandibular fractures can lead to airway compromise, most commonly
secondary to tongue and soft tissue falling against the posterior
pharyngeal wall.

Current Evidence
Mandibular fractures are the third most common facial fractures in children
(behind frontal and nasal bones). Whenever a facial fracture is present, the
cervical spine, CNS, orbits, and teeth need to be carefully evaluated for
associated injuries. The majority of mandibular fractures occur at the level of the
condyle, which often results after trauma to the chin. Other areas of the jaw that
are predisposed to fracture include the angle of the mandible where deep
impacted teeth or unerupted 6-year molars make the mandible more vulnerable.
Symphyseal and parasymphyseal fractures can also accompany upper mandibular
fractures, as part of the closed ring of the jaw.

Goals of Treatment
History, physical examination, and appropriate radiographic evaluation should be
used to establish the diagnosis of mandibular fracture. Patients should be rapidly
evaluated for airway compromise and appropriate management initiated when
identified. Diagnosed jaw fractures are commonly referred for outpatient
treatment, although some injuries may require more urgent intervention.

Mandibular Fractures/Dislocations
Clinical recognition. The mandible can be compared with an archery bow, which
is strongest at its center and weakest at its ends. Thus, most fractures occur at the
neck of the condyles. Patients may present with pain or limitation when opening
the mouth, or swelling at the TMJ.