Fracture of the Jaw (Broken Jaw)

First aid for a suspected broken jaw

1. Protect the airway. Sit upright and lean forward so blood and saliva drain out, unless a neck injury is suspected.
2. Support the jaw gently with your hand or a scarf or bandage wrapped under the chin and over the top of the head. Remove it if you feel sick or need to vomit.
3. Control bleeding by pressing gauze on bleeding gums.
4. Collect knocked-out teeth. Hold by the crown, rinse briefly and keep in milk.
5. Apply a cold pack wrapped in a cloth to reduce swelling.
6. Do not eat or drink until assessed, as surgery may be needed.
7. Go to the ER. Call an ambulance if there is breathing difficulty, heavy bleeding, head injury or possible neck injury.

Symptoms

• jaw pain, worse when chewing or talking
• swelling and bruising of the face or under the tongue
• a bite that feels wrong ("my teeth do not fit")
• difficulty opening or closing the mouth
• jaw moving to one side when opening
• numbness of the lower lip and chin (from injury to the inferior alveolar nerve)
• bleeding from the gums or mouth
• loose or broken teeth
• a step or lump along the jawline
• ear pain or bleeding from the ear canal with fractures near the jaw joint

Upper jaw (maxillary) fractures may cause the face to look lengthened, the upper teeth to move when the upper jaw is pulled, double vision and cheek numbness.

Common fracture sites

The lower jaw is U-shaped and often breaks in two places, frequently one on each side.

Diagnosis

• examination of the face, bite, teeth, nerves and airway
• panoramic X-ray (OPG) of the jaw
• CT scan of the face, the standard for complex or upper jaw fractures, often with a head and neck CT after major trauma
• assessment for associated head and neck injuries, since a jaw fracture often accompanies a head injury or other facial fractures

Treatment

Care is provided by an oral and maxillofacial surgeon, plastic surgeon or ENT surgeon.

Non-surgical treatment

Small, undisplaced fractures with a normal bite, and some condyle fractures, may heal with:

• a soft, no-chew diet for about 6 weeks
• pain relief
• close follow-up

Surgery

• Open reduction and internal fixation (ORIF): the surgeon realigns the bone and fixes it with small titanium plates and screws, usually through incisions inside the mouth. This often allows a soft diet and normal mouth opening soon after surgery
• Maxillomandibular fixation (MMF), "wiring the jaw shut": wires, elastic bands or arch bars hold the upper and lower teeth together for 2 to 6 weeks, sometimes alongside plates
• Removal or repair of damaged teeth
• Antibiotics for fractures that open into the mouth through tooth sockets

Recovery

• Healing time: about 6 weeks for bone to unite
• Diet: liquid or blended diet if wired, then soft foods. Use high-calorie, high-protein shakes to prevent weight loss
• Mouth hygiene: rinse after meals with salt water or prescribed mouthwash, brush carefully
• Wire cutters: if your jaws are wired, carry wire cutters or scissors (for elastics) at all times to release them if you vomit or choke
• Pain relief: acetaminophen (paracetamol) or ibuprofen as directed. Liquid forms are easier if wired
• Avoid contact sports for at least 6 to 8 weeks and until cleared
• Do not smoke, which slows bone healing

Complications

• infection
• non-union or malunion (bone not healing or healing out of position)
• persistent bite problems
• numbness of the lip or chin, which usually improves over months but can be permanent
• jaw joint stiffness or TMJ disorder
• damage to teeth (dental trauma)

Frequently asked questions

How do I know if my jaw is broken?

Signs include severe pain, swelling, teeth that no longer meet properly, difficulty opening or closing the mouth, numbness of the lower lip or chin, bleeding gums and loose teeth after an injury. An X-ray or CT scan confirms it.

How long does a broken jaw take to heal?

Most jaw fractures take about 6 weeks for the bone to heal. Full recovery of chewing strength, comfort and mouth opening may take a few weeks longer. Nerve numbness can take months to improve.

Does a broken jaw always need to be wired shut?

No. Many fractures are now fixed with small plates and screws, which often avoids prolonged wiring. Small stable fractures may need only a soft diet. Wiring is still used in some cases, alone or with plates.

What can you eat with a broken jaw?

If your jaws are wired, you will need a liquid or blended diet: smoothies, soups, protein shakes and blended meals. With plates or a minor fracture, soft foods such as yogurt, eggs, mashed potatoes and pasta are usually allowed for about 6 weeks.

Can a broken jaw heal on its own?

A small, undisplaced fracture with a normal bite can heal with rest and a soft diet. Displaced fractures need surgery to realign the bones. Any suspected jaw fracture should be assessed in the ER.