Clinical Indicators: Mandibular Fracture

1. History
   1. Trauma
   2. Malocclusion perceived by patient
   3. Trismus
   4. Airway patency concerns
2. Physical Examination
   1. Evidence of fracture
   2. Palpate or visualize deformity
   3. Mandibular stability
   4. Assessment of occlusion
   5. Status of dentition
   6. Sensory deficit
   7. Evaluate airway
   8. Other coexisting fractures
   9. Mucosal lacerations over alveolar ridge surfaces
3. Tests
   1. Radiographs
      1. Cervical spine films if appropriate
      2. Panorex versus mandibular series
   2. CT (optional based on other studies and observations)
   3. Pre-operative photos (optional)
   4. Dental consultation (required)

Postoperative Observations

1. Is the airway compromised?
2. Is there any bleeding?
3. Pain?
4. Nausea?
5. Wire ligature pliers or scissors at bedside with interdental fixation?
6. Sensory deficit?
7. Facial nerve intact?
8. Occlusion – returned to baseline?
9. Exposed plates
10. Poor mucosal healing

Outcome Review

1.  One Week
   1. Healing – Any bleeding or infection?
   2. Stability – Are the fixation devices stable?
   3. Dentition – Have any abnormalities been addressed?
   4. Oral hygiene – Is it satisfactory?
   5. Mandible x-rays, if appropriate
   6. Sensory deficit?
   7. Facial nerve
   8. Occlusion
2. Beyond One Month
   1. Healing – Any radiological evidence?
   2. Function – Is mastication satisfactory?
   3. Appearance – Is it satisfactory?
   4. Infection – Did it require treatment, and if so is it controlled?
   5. Inferior alveolar nerve (medial branch) – Is the anesthesia or hypoesthesia resolving
   6. Nutritional status – Is it compromised by inability to chew properly?
   7. Occlusion
   8. Mandibular stability
   9. Facial function
   10. Pain: persistent or resolved (possible malunion or nonunion)

Associated ICD-10-CM Diagnostic Codes (Representative, but not all-inclusive codes)

• S02.609A Fracture of mandible, unspecified, initial encounter for closed fracture
• S02.609B Fracture of mandible, unspecified, initial encounter for open fracture
• S02.609D Fracture of mandible, unspecified, subsequent encounter for fracture with routine healing
• S02.609G Fracture of mandible, unspecified, subsequent encounter for fracture with delayed healing
• S02.609K Fracture of mandible, unspecified, subsequent encounter for fracture with nonunion
• S02.609S Fracture of mandible, unspecified, sequela
• S02.69XA Fracture of mandible of other specified site, initial encounter for closed fracture
• S02.69XB Fracture of mandible of other specified site, initial encounter for open fracture
• S02.69XD Fracture of mandible of other specified site, subsequent encounter for fracture with routine healing
• S02.69XG Fracture of mandible of other specified site, subsequent encounter for fracture with delayed healing
• S02.69XK Fracture of mandible of other specified site, subsequent encounter for fracture with nonunion
• S02.69XS Fracture of mandible of other specified site, sequela
• S02.65XA Fracture of angle of mandible, initial encounter for closed fracture
• S02.65XB Fracture of angle of mandible, initial encounter for open fracture
• S02.65XD Fracture of angle of mandible, subsequent encounter for fracture with routine healing
• S02.65XG Fracture of angle of mandible, subsequent encounter for fracture with delayed healing
• S02.65XK Fracture of angle of mandible, subsequent encounter for fracture with nonunion
• S02.65XS Fracture of angle of mandible, sequela
• S02.67XA Fracture of alveolus of mandible, initial encounter for closed fracture
• S02.67XB Fracture of alveolus of mandible, initial encounter for open fracture
• S02.67XD Fracture of alveolus of mandible, subsequent encounter for fracture with routine healing
• S02.67XG Fracture of alveolus of mandible, subsequent encounter for fracture with delayed healing
• S02.67XK Fracture of alveolus of mandible, subsequent encounter for fracture with nonunion
• S02.67XS Fracture of alveolus of mandible, sequela
• S02.600A Fracture of unspecified part of the body of mandible, initial encounter for closed fracture
• S02.600B Fracture of unspecified part of the body of mandible, initial encounter for open fracture
• S02.600D Fracture of unspecified part of the body of mandible, subsequent encounter for fracture with routine healing
• S02.600G Fracture of unspecified part of the body of mandible, subsequent encounter for fracture with nonunion
• S02.600S Fracture of unspecified part of the body of mandible, sequela
• S02.66XA Fracture of symphysis of mandible, initial encounter for closed fracture
• S02.66XB Fracture of symphysis of mandible, initial encounter for open fracture
• S02.66XD Fracture of symphysis of mandible, subsequent encounter for fracture with routine healing
• S02.66XG Fracture of symphysis of mandible, subsequent encounter for fracture with delayed healing
• S02.66XK Fracture of symphysis of mandible, subsequent encounter for fracture with nonunion
• S02.66XS Fracture of symphysis of mandible, sequela
• S02.61XA Fracture of condylar process of mandible, initial encounter for closed fracture
• S02.61XB Fracture of condylar process of mandible, initial encounter for open fracture
• S02.61XD Fracture of condylar process of mandible, subsequent encounter for fracture with routine healing
• S02.61XG Fracture of condylar process of mandible, subsequent encounter for fracture with delayed healing
• S02.61XK Fracture of condylar process of mandible, subsequent encounter for fracture with nonunion
• S02.61XS Fracture of condylar process of mandible, sequela
• S02.63XA Fracture of coronoid process of mandible, initial encounter for closed fracture
• S02.63XB Fracture of coronoid process of mandible, initial encounter for open fracture
• S02.63XD Fracture of coronoid process of mandible, subsequent encounter for fracture with routine healing
• S02.63XG Fracture of coronoid process of mandible, subsequent encounter for fracture with delayed healing
• S02.63XK Fracture of coronoid process of mandible, subsequent encounter for fracture with nonunion
• S02.63XS Fracture of coronoid process of mandible, sequela
• S02.64XA Fracture of ramus of mandible, initial encounter for closed fracture
• S02.64XB Fracture of ramus of mandible, initial encounter for open fracture
• S02.64XD Fracture of ramus of mandible, subsequent encounter for fracture with routine healing
• S02.64XG Fracture of ramus of mandible, subsequent encounter for fracture with delayed healing
• S02.64XK Fracture of ramus of mandible, subsequent encounter for fracture with nonunion
• S02.64XS Fracture of ramus of mandible, sequela
• S02.62XA Fracture of subcondylar process of mandible, initial encounter for closed fracture
• S02.62XB Fracture of subcondylar process of mandible, initial encounter for open fracture
• S02.62XD Fracture of subcondylar process of mandible, subsequent encounter for fracture with routine healing
• S02.62XG Fracture of subcondylar process of mandible, subsequent encounter for fracture with delayed healing
• S02.62XK Fracture of subcondylar process of mandible, subsequent encounter for fracture with
  nonunion
• S02.62XS Fracture of subcondylar process of mandible, sequela

Additional Information

Mandibular fractures can be associated with other serious injuries:

1. Patency of airway must be assured first
2. Control of hemorrhage
3. Level of consciousness assessed
4. Other facial fractures
5. Cervical trauma
6. Tetanus prevention

Assistant Surgeon – Y/N

Patient Information

Fractures of the mandible (lower jaw) can occur alone or in combination with other facial injuries. The goal of treatment is to allow correct healing and satisfactory function. Treatment of these fractures is by wiring or plating the fractures together or wiring upper and lower jaws together (intermaxillary/maxillomandibular fixation), or a combination of the above. Certain fractures may require only soft diet and pain relievers. Special dental treatment plans may be required for children.

Complications or unsatisfactory results may develop after surgery. Infection, slow or impaired
healing, nonhealing of the fracture or healing in an incorrect position,, malocclusion, numbness, facial weakness and scaring are some of the unsatisfactory outcomes. As with any other type of surgery, bleeding or infections are possible short term complications, though fortunately, these are rare. Some patients may also develop thick scar tissue or keloid.

Important Disclaimer Notice (Updated 8/7/14)

Clinical indicators for otolaryngology serve as a checklist for practitioners and a quality care review tool for clinical departments. The American Academy of Otolaryngology—Head and Neck Surgery, Inc. and Foundation (AAO-HNS/F) Clinical Indicators are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care. The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical indicators will not ensure successful treatment in every situation. The AAO-HNS/F emphasizes that these clinical indicators should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. The AAO-HNS/F is not responsible for treatment decisions or care provided by individual physicians. Clinical indicators are not intended to and should not be treated as legal, medical, or business advice.

CPT five-digit codes, nomenclature and other data are copyright 2014 American Medical
Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings
are included in CPT. The AMA assumes no liability for the data contained herein.

Updated January 2015

© 2014 American Academy of Otolaryngology-Head and Neck Surgery.