Complete trauma evaluation, including ABCs (airway, breathing, circulation).

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  Must evaluate risk for airway compromise. Rarely, intubation may be necessary to protect the airway.

  
  
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  Evaluate for associated injuries, including cervical spine injuries.

Difficult to assess history in children. They may describe jaw pain with movement and noticeable changes in occlusion.

Inspect face for asymmetry and areas of tenderness, swelling, or ecchymosis.

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  Ecchymosis of preauricular areas can indicate underlying fractures.

  
  
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  Chin laceration may indicate superiorly directed force consistent with condylar fractures.

  
  
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  Deviation of jaw opening or limited mobility.

  
  
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  Intraoral examination may reveal lacerations or hematomas; evaluate for dental injuries, including presence of permanent dentition.

  
  
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  Body/angle fractures may affect the inferior alveolar nerve, causing numbness of the lower lip and teeth.

State of dentition

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  Children ages 6 to 12 will present in various states of mixed dentition. Younger children will have permanent tooth roots deep to their primary dentition. These factors will critically influence a surgeon’ s options for reconstruction of injuries.

  
  
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  Assess for dental fracture, stability, tooth root exposure, and caries.

High-resolution maxillofacial computed tomography: Gold standard for evaluation of facial trauma. Three-dimensional reconstructions may assist in evaluating injury. Maximum-intensity projection view (when available) can reveal dentition for evaluation of tooth roots.

Panorex: Requires patient cooperation, and patient must be upright for the study. Allows visualization of the entire mandible and dentition. Towne view adds improved evaluation of condyles.

Plain radiography (mandible series with anteroposterior, lateral, oblique, and open-mouth Towne view): These studies are of limited benefit in younger patients, whose skeletons are less calcified than those of adults.