Is routine cervical spine radiographic evaluation indicated in patients with mandibular fractures?

Fractures of the mandible are commonly seen in most urban trauma centers. Over the past decade, the authors have seen a rise in these injuries secondary to an increase in drug and alcohol abuse, violent crime, and high-speed motor vehicle accidents. Several reports have described an association between mandibular fractures and cervical spine injuries and recommend routine cervical spine radiographs in all patients with mandibular injuries. These studies have failed to show a "cause and effect" relationship because of concomitant injuries found in these patients. This study reviews mandibular fractures and cervical spine injury retrospectively and prospectively over a 3-year period. The retrospective study included patients with isolated mandibular fractures who came to Cooper Hospital/University Medical Center Emergency Room in 1987. Thirty patients were identified, 18 of whom had cervical spine x rays. No patients had a significant radiologic or clinical cervical spine injury. The prospective study included all patients with mandibular fractures seen in the emergency room during 1988 and 1989. Seventy-three patients were identified, 44 of whom had mandibular and cervical spine radiographs. None had a significant radiologic or clinical cervical spine injury. The authors conclude that routine cervical spine x rays are costly and unnecessary. Also, any patient with a suspicion of concomitant cervical spine injury (i.e., patients with a loss of consciousness, multi-organ system injury, cervical pain or tenderness, or intoxication from alcohol use) should have cervical spine x rays, including anteroposterior, lateral, and open-mouth odontoid views.