Fractures of the Lower Jaw (Mandible)

Your lower jaw has been fractured. You surgeon will examine you and establish the number of fractures and what treatment you will require to correct the problem. The treatment you will undergo will require a general anaesthetic.

Once you have been put under the general anaesthetic, the fracture sites will be opened up. This involves making an incision on the inside of your mouth through the gum. The broken bones are then repositioned together and held in place with small metal plates and screws. The gum is stitched back into place with dissolvable stitches. It can take up to a fortnight or even longer for them to dissolve.

During the surgery, in rare circumstances, wires or metal braces must be placed around your teeth. This is so that elastic bands can be attached to them and guide your bite into the correct position after surgery. Screws inserted into the jawbone above the teeth are occasionally used instead of these wires or metal braces. Any elastic bands are not usually attached until the day after your operation. i.e. you will be able to move your jaws freely when you wake up.

Occasionally, it is necessary to remove damaged or decayed teeth at the site of the fracture. In very difficult fractures it is sometimes necessary to make an incision on the outside of the mouth through the skin. If you are to undergo this procedure, the site and size of the incision will be discussed with you prior to you consenting to this surgery.

It is likely that you will be sore and tender following the surgery and pain relief will be given to you. The discomfort is usually worse over the first few days, although it may take a couple of weeks to completely resolve. It is also necessary to make sure that the fractures heal without any infection and so you will be given antibiotics whilst you are in hospital and when you are discharged.

You will be required to stay in hospital overnight following the surgery. The following day you will undergo an x-ray to check the position of your fractures prior to you being discharged from hospital.

Although the plates and screws hold the fractures in place, it may take around six weeks for your lower jaw to heal completely. During this period you will need to consume a relatively soft diet which will be discussed with you. It is important that you are diligent in maintaining a scrupulously clean mouth for the first few weeks following surgery to prevent infection. It may however be difficult to clean your teeth around the site of the stitches due to tenderness. It is advisable to keep the area free from food debris by gently rinsing your mouth with a mouthwash or warm salt water commencing on the day following surgery. If any wires, metal braces or screws are used to help guide your bite into the correct position, they will be removed when your surgeon is happy that your fracture has healed completely.

Depending on the nature of your work, it may be advisable to take a couple of weeks off work and avoid strenuous exercise for this period. It is important that 48 hours following surgery that you avoid driving or operating machinery.

• Infection is uncommon as you will be taking antibiotics.
• Bleeding from the incision sites inside your mouth is unlikely to cause a problem. However, if the area does bleed this can usually be stopped by applying pressure over the site for at least ten minutes with a swab.
• The nerve that runs through the centre of the lower jaw that supplies sensation to your lower lip, chin and bottom teeth may be bruised at the time of your fracture. As a result, you may experience some tingling or numbness in your lip or chin. This tingling may also be caused or exacerbated by the surgery. For most people the numbness improves on its own, although it can take several months to do so.
• Occasionally, teeth adjacent to the fracture site may be damaged by screws that are used.
• If you have had plates or screws inserted to hold your jaw in the correct position, these are not normally removed unless they become infected. However, they tend not to cause any problems. The metal that is used is titanium which does not alert metal detectors in airports.

A review appointment will be arranged for you to be seen by your surgeon to ensure that your jaws are healing well.

If you have any post-operative concerns, you should contact your surgeon directly and not any other healthcare professionals.