A 23-year-old woman presents with lower jaw pain after blunt trauma. She denies dental malocclusion but seems to have mild trismus on exam. There is no significant intraoral trauma and there are no other apparent injuries. She is able to break a rotated wooden tongue blade between her molars bilaterally. What is the most accurate advice you can provide the patient regarding the need for panoramic x-ray and/or CT imaging to rule out a mandibular fracture?
a. All patients with facial pain following trauma should have a CT of the facial bones.
b. The absence of intraoral bleeding excludes the possibility of fracture
c. About 95% of patients with a mandible fracture cannot pass the tongue blade test, and a negative tongue blade test means the chance of fracture is less than 10%.
d. Any degree of trismus following facial trauma indicates a 95% likelihood of mandibular condyle fracture.
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Answer: C. The tongue blade test can be helpful to assess patients with jaw pain following trauma. A passed tongue blade test carries a 92% negative predictive value for mandibular fracture.
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