Jaw Fracture Repair

Jaw fracture repair is a surgical procedure that realigns and stabilises broken bones in the lower jaw (mandible) or upper jaw (maxilla) so they can heal in the correct position.

When a jaw bone breaks, the two ends of the fracture shift out of alignment, making it impossible to bite, chew, or speak properly. During the repair, an oral and maxillofacial surgeon repositions the bone fragments back into their natural alignment — a process called reduction — and then holds them firmly in place using metal plates, screws, or wires until the bone knits back together. In some cases, the upper and lower teeth are wired or banded shut temporarily to keep the jaw still while it heals.

This procedure is used whenever a jaw bone is fractured and cannot heal safely on its own without surgical support. The most common causes are physical trauma to the face, but there are several specific situations in which surgery is recommended.

• Fractures caused by road traffic accidents, falls, or sports injuries
• Jaw fractures resulting from physical assault or violence
• Broken jaw bones caused by a tumour weakening the bone from the inside — known as a pathological fracture
• Fractures in multiple locations along the jaw at the same time
• Fractures where the bone ends have moved significantly out of place (displaced fractures)
• Fractures involving the teeth or the tooth-bearing part of the jaw
• Fractures that have not healed properly after an earlier attempt (malunion or nonunion)

Surgery may not be recommended in certain situations. A surgeon will carefully assess each case before deciding.

• Very minor, hairline fractures where the bone has not moved and the bite is normal — these may be managed with rest and a soft diet alone
• Patients whose general health is too poor to safely tolerate general anaesthesia
• Active, uncontrolled infection at the fracture site that must be treated before surgery can proceed safely

Like all surgery on the face and jaw, this procedure carries recognised risks, and your surgical team will discuss these with you before you consent to the operation.

• Swelling and bruising of the face, which is expected and usually peaks in the first few days
• Pain and discomfort at the repair site during the healing period
• Infection at the wound or around the metal hardware placed inside the jaw
• Numbness or tingling in the lower lip, chin, or teeth, caused by temporary pressure on the nearby inferior alveolar nerve (the main nerve running through the lower jaw) — this usually improves over weeks to months but can occasionally be long-lasting
• Difficulty opening the mouth fully (trismus) after surgery, which often improves with jaw exercises
• Malocclusion — the upper and lower teeth not meeting correctly after healing, which may need further treatment
• Delayed healing or failure of the bone to unite, more common in smokers or people with certain medical conditions
• Loosening, displacement, or irritation from the metal plates or screws, sometimes requiring a second procedure to remove them
• Scarring, either on the skin if an external cut was made, or inside the mouth
• Reactions to general anaesthesia, which are assessed and managed by the anaesthetic team

Preparation for jaw fracture repair usually begins in the days before surgery. Because the procedure is performed under general anaesthesia, the stomach must be empty to reduce the risk of inhaling stomach contents during the operation. Your care team will give you specific fasting instructions — typically no food or drink for several hours beforehand — and it is important to follow these exactly.

Your doctor will review all medications you are currently taking. Blood thinners and certain anti-inflammatory medicines are usually paused before surgery because they increase bleeding risk. Do not stop or change any medication without guidance from your care team. Smoking significantly slows bone healing and increases infection risk, so patients are strongly advised by their doctors to stop smoking as far in advance of surgery as possible. Alcohol should also be avoided in the days before the procedure.

Before surgery, the team will usually carry out several assessments to plan the operation and check that you are safe to proceed:

• Imaging of the jaw — usually a CT scan (computed tomography, a detailed three-dimensional X-ray) or panoramic dental X-ray — to map the exact location and pattern of the fractures
• Blood tests to check for anaemia (low red blood cells), infection, and how well the blood clots
• An assessment of the bite (occlusion) by looking at how the upper and lower teeth fit together
• A general health check including heart and lung assessment before anaesthesia
• Dental X-rays if teeth near the fracture line may be affected

On the day of surgery, the procedure typically follows these steps:

• 1. You are welcomed into the operating area and settled onto the operating table.
• 2. The anaesthetic team places a drip (intravenous line) in your arm and gives you medicines to put you into a deep sleep — general anaesthesia.
• 3. A breathing tube is placed through your nose or mouth to keep your airway open throughout the operation.
• 4. The surgeon cleans the area and makes incisions (cuts) — usually inside the mouth to avoid visible scars, though some fracture locations may require a small cut on the skin outside the jaw.
• 5. The fractured bone fragments are carefully repositioned to restore the normal alignment of the jaw and the natural fit of the teeth.
• 6. Metal plates, screws, or wires are fixed to the bone to hold the fragments in place — this hardware is usually left permanently, though it can be removed later if needed.
• 7. In some cases, the upper and lower teeth are wired or banded together (intermaxillary fixation) to give the jaw extra stability while healing begins.
• 8. The incisions are closed with stitches, and the area is cleaned.
• 9. Anaesthesia is stopped, you are allowed to wake up, and the breathing tube is removed when you are breathing safely on your own.
• 10. You are moved to a recovery area where your breathing, blood pressure, and pain are monitored as the anaesthetic wears off.

Recovery from jaw fracture repair takes time, and the pace varies depending on how severe the fracture was, whether the jaw is wired shut, and each patient's general health. Most patients stay in hospital for at least one night so that pain, swelling, and breathing can be closely monitored. Your care team will give you personalised instructions before you are discharged.

• Diet: You will be placed on a liquid or very soft diet for several weeks — sometimes longer if the jaw is wired shut — because chewing puts direct force on the healing bone. Your doctor or dietitian will advise on how to get enough nutrition through smoothies, soups, and pureed foods.
• Jaw wiring: If intermaxillary fixation (wiring the teeth together) was used, the wires or bands are usually removed by the surgeon after a number of weeks, once the bone has begun to unite. You should always carry small wire cutters or scissors provided by your team in case of vomiting, to prevent choking.
• Oral hygiene: Keeping the mouth clean is critical to prevent infection. Your team will show you how to rinse gently with an antiseptic mouthwash and clean around the wires or stitches without disturbing the repair.
• Pain and swelling: Swelling of the face is expected to peak in the first two to three days and then gradually reduce. Your doctor will prescribe pain relief and, if there is infection risk, antibiotics. Cold packs applied gently to the outside of the face can help with swelling in the early days.
• Activity restrictions: Heavy lifting, strenuous exercise, and contact sports must be avoided for several weeks. Your surgeon will set a specific timeline based on your fracture and your healing progress.
• Work and school: Many patients need several weeks off work or school, especially if their job involves physical effort or speaking for long periods.
• Follow-up appointments: Regular check-ups are essential. Your surgeon will take repeat X-rays or imaging at intervals to confirm the bone is healing correctly and to monitor the hardware.
• Jaw exercises: Once the bone has healed sufficiently, your doctor may refer you to a physiotherapist who specialises in jaw rehabilitation to help you regain a full range of mouth opening.
• Smoking and alcohol: Smoking must be avoided throughout the healing period as it severely impairs bone healing. Alcohol is also best avoided, particularly while on certain medications.
• When to seek help urgently: Contact your care team straight away if you develop a high fever, increasing rather than decreasing pain, difficulty breathing, heavy bleeding from the mouth, or notice the hardware has moved or broken.