Mandibular Fracture — ORE Part 1 MCQ

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HardOral SurgeryMandibular FractureORE Part 1

A 45-year-old man presents with a displaced fracture of the left angle of the mandible following an assault. He has numbness of the left lower lip and an obvious step deformity in the occlusion. What is the most appropriate initial management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Stabilise with a bridle wire and refer urgently to oral and maxillofacial surgery

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D

A displaced fracture of the mandibular angle with step deformity and inferior alveolar nerve deficit is a surgical emergency requiring urgent secondary care assessment and intervention. The primary-care dentist should provide temporary stabilisation (bridle wire) to reduce mobility and pain during transport, then immediately refer to oral and maxillofacial surgery via the established emergency pathway. Options B and C risk non-union, malunion, and permanent functional loss by delaying definitive treatment. Option D exceeds the scope of primary dental practice (no theatre, imaging, or surgical expertise) and does not provide the standard of care for complex angle fractures. Option E delays urgent referral unnecessarily; imaging is arranged by OMFS, not the primary dentist.

Reference: Scottish NHS, Oral and Maxillofacial Surgery: Initial Assessment, Management and Referral of Common Maxillofacial Presentations – Fractures of the Mandible (approved 2025-04-23); https://www.rightdecisions.scot.nhs.uk/media/04thi3ao/fractures-of-the-mandible_initial-assessment-management-and-referral-of-common-maxillofacial-presentations.pdf