Intended for healthcare professionals

Endgames Case Review

Managing a patient with pain and facial swelling

BMJ 2019; 366 doi: (Published 22 August 2019) Cite this as: BMJ 2019;366:l4519
  1. Rory Houston, core surgical trainee1,
  2. Sarah L Ball, dental surgeon and associate clinical lecturer2,
  3. James Adams, oral and maxillofacial consultant1,
  4. Stephen L Ball, ear, nose, and throat registrar and NIHR academic clinical lecturer3
  1. 1Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
  2. 2Newcastle Dental Hospital and University, Newcastle upon Tyne, UK
  3. 3Newcastle University and Hospitals, Newcastle upon Tyne, UK
  4. Correspondence to R Houston

A 32 year old man presented to the emergency department with trismus and a painful swollen right side of his face. He was intoxicated and unable to provide a clear history, but he mentioned an argument in the pub. A radiograph of the area was requested (fig 1).

Fig 1

Posteroanterior mandible radiograph


  1. What is the diagnosis?

  2. What signs may be related to this diagnosis?

  3. How would you manage this initially?


1. What is the diagnosis?

Fracture of the right para-symphysis and left condyle of the mandible. The …

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