University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Emergency Medicine


Dr. Elyse J Watkins, DHSc, PA-C, DFAAPA


Mandibular fractures are a common occurrence among young males aged between 16 and 30 years. They are the most common type of injuries in the trauma settings in hospitals and comprise a higher percentage of facial bone fractures. Given the possibility of the emergency department turning chaotic, it is imperative to reduce the wait times as much as possible. Although x-rays and CT scans have been defined in literature and practice as the best diagnostic tools of mandibular fractures, there is evidence to suggest that Tongue Blade Bite Test (TBBT) might be of diagnostic value in ruling out mandibular fractures and ordering advanced imaging modalities. X-rays have a sensitivity of 74% and specificity of 78%, so they are not sufficient to effectively evaluate for mandibular fracture. On the other hand, the Computer tomography (CT), which is the current gold standard, is the imaging modality of choice when assessing a traumatic mandibular injury and can demonstrate a 100% sensitivity in detecting a fracture. However, given that the incidence of trauma to the mandible is higher compared to the prevalence of midface trauma, there have been objections to CT scans on the grounds of high costs for suspected mandibular fracture. The above reason, coupled with high radiation exposures with CT and X-rays mandate for an inexpensive yet reliable alternative in the detection of fractures of the mandible. The TBTT is useful and reliable in ruling out or confirming the suspected mandibular fracture. In this view, the purpose of performing literature research is to evaluate the efficiency of a TBBT of both the pull method TBBT and the break method TBBT in predicting mandible fractures to decide on patients presenting to the emergency department (ED) or urgent care (UC) with a suspected mandibular fracture. Both TBBT methods have a high percentage of sensitivity and specificity as a CT scan, and if utilized correctly, will limit radiation exposure and expensive diagnostic tools making it a useful screening tool to rule-out mandible fractures.

Keywords: tongue blade test, mandible fracture, facial trauma, maxillofacial injuries


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