This is a quick resource adapted from Dental Emergencies by Wiley Publishing
Dental Emergencies, Editors: Mark Greenwood, Ian Corbett (2013)
A swelling is defined as a transient enlargement or protuberance of part of the body and may arise intra-orally or externally around the face, jaws and neck. Acute swellings are usually caused by trauma, or infection and inflammation.
Traumatic swellings include haematoma, facial or dento-alveolar fractures and temporomandibular joint effusions or dislocations. Fractures inevitably display localised swelling, bruising and deformity and the patient will experience both pain and some loss of function. The precise history of the preceding injury, examination of the anatomical site involved and standard radiographic assessment will help clarify the diagnosis, and these cases should be referred to specialist oral and maxillofacial surgery opinion.
Unilateral condyle
Fracture side:
- Pain, swelling, bruising
- Joint immobility
- Deviation of mandible on mouth opening
- Premature tooth contact
Opposite side:
- Lateral open bite
- Inability to move mandible laterally
Bilateral condyle
- Pain, swelling, bruising and immobility of both joints
- Anterior open bite
- No lateral mandibular movement possible
Mandible
- Pain, swelling, bruising at site of fracture
- Trismus
- Abnormal mobility of fractured segments
- Step deformity at lower border of mandible
- Deranged occlusion
- Numbness of lip and chin
Zygomatico-orbital complex
- Pain, swelling, bruising over cheek and around eye
- Subconjunctival haemorrhage
- Later, flattening and depression of cheek prominence
- Step deformity at infra-orbital margin
- Numbness of upper lip, lateral nose and cheek
- Intra-oral bruising in upper buccal sulcus
- Trismus if coronoid process impacts on displaced zygoma
Middle third fractures
- Can be gross facial swelling and tenderness
- Bilateral circumorbital bruising
- Mobility at infra-orbital margins or zygomatico-frontal sutures
- Widespread facial numbness
- Deranged occlusion with anterior open bite
- Mobile maxillary alveolus