How should I assess and manage a patient presenting with a mandibular fracture in primary care?

When assessing a patient presenting with a mandibular fracture in primary care, initial evaluation should focus on a thorough clinical examination to identify the site and extent of the fracture, assess for deformity, malocclusion, swelling, bruising, and any open wounds. Neurovascular status must be carefully documented, including sensory and motor function of the facial nerve branches and assessment of airway patency, as airway compromise is a critical concern in mandibular fractures ¹.

Immediate management involves ensuring airway stability, controlling bleeding, and providing adequate analgesia. If there is any suspicion of airway obstruction, severe bleeding, or open fractures, urgent referral to secondary care or emergency services is mandatory ¹.

Imaging is essential for diagnosis and treatment planning. While primary care does not typically perform imaging for mandibular fractures, prompt referral for radiological assessment (e.g., orthopantomogram or CT scan) is required to confirm the diagnosis and evaluate fracture complexity ¹.

Patients should be advised on self-care measures such as soft diet, oral hygiene, and avoiding activities that may exacerbate injury. Written and verbal information about expected outcomes, rehabilitation, and signs of complications should be provided ¹.

Referral pathways must be clear and timely. Patients with suspected mandibular fractures should be referred urgently to maxillofacial or trauma services for specialist assessment and management, especially if there is displacement, open wounds, or neurovascular compromise ¹.

Documentation of all findings and communications is essential to ensure continuity of care and support multidisciplinary management ¹.

While the UK guidelines focus on structured assessment, referral, and patient information, literature on facial fractures emphasizes the importance of early recognition and management of airway and bleeding complications, which aligns with guideline priorities (Kucik et al., 2004). This integrated approach ensures patient safety and optimizes outcomes.