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Adult Jaw Fracture Nutrition Therapy
Dietetics Practice Guidelines
Madeline Kinzly, OHSU Dietetic Intern

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}aw fiactuies aie uesciibeu as follows:
0pen- exposeu to open aiea of mouth oi skin
Closeu- within tissue
Complete- bone bioken in two sepaiate pieces
Incomplete- splinteieu
Comminuteu- multiple pieces
The type of fiactuie, in auuition to othei meuical conuitions will ueteimine the type of suigeiy that
the patient will have. Suigical iepaii incluues ieuuction anu fixation of the fiactuie. Reuuction is
when the bioken poition of the jaw is "set in place". Then fixation will incluue eithei anu exteinal oi
inteinal use of the uppei jaw to holu the lowei jaw in place while healing occuis. This is commonly
iefeiieu to as "wiiing the jaw", oi maxillomanuibulai fixation. The nutiition theiapy iequiieu will
neeu to be ueteimineu baseu on the suigeiy anu inuiviuualizeu foi the client (1, 2).

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}aws aie typically immobilizeu foi 6-8 weeks making foou intake painful anu uifficult. This puts
patients at incieaseu iisk foi weight loss, uue to fat anu muscle wasting, uehyuiation, vitamin
ueficiencies, anemia anu malnutiition (S, 4). In a stuuy looking at bouy composition of patients who
hau jaw fiactuies with fixation, mean weight loss at 1 week postopeiative was 2.S kg anu S.2 kg at 6
weeks postopeiative, with the majoiity of loss as lean bouy mass (S). In auuition to the inability to
consume soliu foous, patients may uevelop mouth soies, infections oi pain fiom the haiuwaie placeu
in the mouth making foou intake less uesiiable anu incieasingly painful (S). In an animal stuuy, iats
with conuylai jaw fiactuie weie submitteu to a hypopiotein uiet (8% piotein) (6). Piotein
unueinouiishment in iats with jaw fiactuies iesulteu in significant weight loss, maikeu ueciease in
values of seium piotein anu albumin, catabolism, significantly sloweu healing of the bone anu fibious
ankylosis (excessive connective tissue accumulation iesulting in uecieaseu iange of motion anu
ieuuceu mobility) (6).

5)(&.(./, 1.":,/2.24
Common nutiition uiagnoses foi clients with jaw fiactuies may incluue, but aie not limiteu to, the
following (7):
Inauequate oial intake (NI-2.1)
Inauequate fluiu intake (NI-S.1)
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Incieaseu nutiient neeus (specify) (NI-S.4)
Bitingchewing (masticatoiy) uifficulty (NC-1.2)
0nintentional weight loss (NC-S.4)

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The patient will consume auequate caloiies foi weight maintenance.
o 2S-Su kcalkg foi healthy auults (aujust baseu on co-existing conuitions oi tiauma)
The patient will consume auequate nutiients, especially piotein, vitamins, mineials anu fibei
to suppoit noimal activity anu piomote healing.
o Piotein 1.u-1.S gkg (aujust baseu on co-existing conuitions oi tiauma)
o Baily fibei to maintain bowel iegulaiity:
Age Su anu youngei Age S1 anu oluei
Women S8 giams Su giams
Nen 2S giams 21 giams

The patient will consume auequate fluiu to maintain noimal hyuiation.
o In the absence of comoibiu conuitions (e.g. ienal oi livei failuie, septic shock) in
oiuei to maintain auequate hyuiation, fluiu iequiiements anu intake aie similai to
that of noimal healthy inuiviuuals.
o 1 mlkcal uaily (aujust baseu on co-existing conuitions, tiauma oi othei losses)
When the patient is not able to meet neeus with foou, heshe will successfully select anu use
appiopiiate nutiitional supplements

1.*("&? C/,2.-*&"(./,24
Patients iequiiing fiactuieu jaw nutiition theiapy will not be able to chew soliu foous anu will neeu
to consume a blenuaiizeu uiet. Patients will neeu to use a blenuei oi foou piocessoi that has
sufficient powei to ieuuce meats anu coaise foous to the uesiieu consistency, foou may neeu to be
fuithei stiaineu to iemove laige paiticles that uon't blenu well (2, 7, 8). All nutiients can be
pioviueu by nutiition theiapy, but caieful planning is iequiieu to ensuie that auequate fibei anu
othei nutiients aie pioviueu. A liquiu multivitamin supplement is iecommenueu to ieuuce the iisk
of vitaminmineial ueficiencies anu inciease wounu healing (2). Antibiotics aie often useu in the
tieatment piocess of fiactuieu jaws to ieuuce complications, ueciease infection uue to
contamination of oial floia, anu inciease healing (8). Piobiotics shoulu be iecommenueu to aiu in
maintenance of gut miciofloia anu loweieu inciuence of uiaiihea.
Piepaie foous by iemoving skins, seeus, anu peels (they can get lougeu between teeth, gums
oi wiies).
Cook meats anu vegetables thoioughly.
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Cut foous into small pieces anu mix with a small amount of liquiu in a blenuei oi foou
piocessoi. Continue to auu liquius until foous become thin enough to sip thiough a stiaw.
Avoiu alcohol oi any foou that may cause vomiting.
Nany foous blenu moie easily when waim, heat foous appiopiiately befoie liquefying
(auvise patients to test the tempeiatuie of theii foou befoie consuming to avoiu buining lips
oi mouth, colu tempeiatuies may also huit sensitive teeth).
Eat S-6 small meals pei uay (eveiy2-S houis) to maximize caloiie anu piotein intake.
Clean mouth at least thiee times uaily using waim salt watei oi piesciibeu oial mouth iinse.
0ial hygiene will help to ieuuce iisk of infections, thiush, tooth uecay anu will make the
patient feel bettei anu foous taste bettei. If soies in the mouth occui, avoiu foous that aie
highly aciuic, such as oiange, giapefiuit anu tomato juice, oi foous that might exaceibate oial
uiscomfoit (S).

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Supplements may be iecommenueu foi some patients who aie unable to meet caloiie, piotein, oi
vitaminmineial intake. Piouucts such as piotein powueis, soy piotein powuei, instant bieakfast
mixes, powueieu milk, powueieu eggs, anu bottleu commeicial high pioteinhigh caloiie uiinks anu
milkshakes (7).

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This uiet shoulu be useu aftei jaw oi mouth suigeiy, wiieu jai suigeiy, oi uental suigeiy. The
consistency of foous in this uiet shoulu be thin enough to be sippeu fiom a stiaw. Although stiaws
may not fit in the small space between the teeth, in this case a syiinge fitteu with a length of flexible
tubing to auministei foou anu fluius may be iequiieu (2, 7). It is impoitant to note that moue of
intake may neeu to be inuiviuualizeu to ensuie passage of blenuaiizeu uiet thiough opening between
teeth aftei suigical iepaii anu a uietitian will neeu to woik with a patient to ueteimine intake ioute
(2). Patients shoulu be sitting up stiaight in a chaii uuiing eating episoues to ieuuce the iisk foi
choking oi vomiting (7).

C/,(&".,-.'"(./,24
Patients may have sustaineu othei, moie seiious injuiies, in conjunction with a jaw fiactuie anu
maxillomanuibulai fixation. These injuiies may iequiie patients to be seuateu, cause cognitive
impaiiments, inciease basal metabolic iate anuoi iequiie suigeiies. In any of these situations
enteial nutiition shoulu be consiueieu to ensuie patient is getting auequate nutiition (4).




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Foou uioup Foous Recommenueu Piepaiation Thin With To Inciease
CaloiiesPiotein
Special Consiueiations
F.<7 ",-
F.<7
3&/-)'(2
All Blenu soliu uaiiy
piouucts; blenu
fiuiteu yoguit
anu iemove
pieces of fiuit that
uo not blenu well
Nilk, juice, oi
nutiitional
supplement
Auu uiy milk powuei,
instant bieakfast, anu
nutiitional
supplements, fiozen
oi powueieu egg
piouucts.
Foi lactose intoleiance, use
lactose fiee piouucts, soy milk,
oi iice milk. To ieuuce fat, use
low fat oi non-fat piouucts.
F*"( ",-
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3&/(*.,
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Tenuei, well-cookeu
meat, poultiy, oi fish
piepaieu without
bones, skin, oi auueu
fat
Well-cookeu eggs
piepaieu without fat
Soft soy foous (like
tofu)
Smooth nut butteis
Cook tenuei,
blenu, anu stiain
to iemove laige
pieces, anu then
to liquiu
consistency.
Stiaineu baby
foou may be useu
if uesiieu. Auu a
vaiiety of
Liquiu fiom
cooking, thin
sauces, giavies,
bioth, milk,
vegetable juice,
soup
Auu uiy milk powuei,
piotein powuei,
fiozen oi powueieu
egg piouucts, oi
nutiitional
supplements.
Aviou eating iaw eggs uue to
possible salmonella.
;&".,2 Rice
Pasta
Couscous
Cookeu ceieals, such as
oatmeal anu cieam of
wheat
Cook, blenu, anu
thin.
Nilk, bioth,
fiuit oi
vegetable juice,
sauce
Auu melteu buttei,
maigaiine, oi oil.
Avoiu whole-giain ceieals anu
those with nuts, seeus anu
uiieu fiuits.
H*:*("I<*2 Any cookeu oi canneu
vegetables without
seeus anu skins
0se cookeu oi
iaw, season as
uesiieu. Remove
skin anu seeus.
Blenu oi use foou
piocessoi to
liquefy.
Bioth, giavies,
fiuit oi
vegetable juice,
milk, soups
Auu melteu buttei,
maigaiine, oi oil, thin
cheese sauce
Avoiu vegetables with seeus oi
tough skins.
%&).(2 Any cookeu oi canneu
fiuits without seeus
anu skins
Fiesh, peeleu soft fiuits
(like peaches anu
bananas) that can be
blenueu until smooth
0se cookeu oi
iaw, season as
uesiieu. Remove
skin anu seeus.
Blenu oi use foou
piocessoi to
liquefy.
Bioth, giavies,
fiuit oi
vegetable juice,
milk, soups
Auu juice, honey,
syiup, cieam, oi tofu
Avoiu fiuits with seeus oi
tough skins.
%"(2 ",-
G.<2
Any oils
Nelteu buttei oi
maigaiine
0se to auu
caloiies anu
flavoi
Nilk, fiuit juice,
cieam, sauces
To ieuuce cholesteiol, use
polyunsatuiateu oi
monounsatuiateu fats anu oils
J*K*&":*2 Any
Look foi liquiu
supplements that
pioviue both caloiies
anu piotein, such as
Caination Instant
Bieakfast, Boost, oi
Ensuie
Beveiages can be
auueu to othei
blenueu foous foi
thinning, no
fuithei
piepaiation is
neeueu
Avoiu alcoholic beveiages as
they my inuuce vomiting anu
slow healing
G(9*& uiounu spices, seeus,
anu nuts

Besseits- cakes anu
cookies
0se any that will
enhance flavois
oi othei foous.
Stiain out any
that will not
blenu
Soak cakes anu
cookies in milk,
then blenu
smooth.
Avoiu ovei use of stiong
flavoieu seasonings such as
onion anu gailic because the
taste is haiu to clean fiom the
mouth.
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7

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1. Lee C, Bamm BB, Neville BW, Allen C, Bouquot }. 0ial anu Naxillofacial
Pathology: Elseviei Bealth Sciences, 2uu8.
2. Nelms N, Suchei K, Lacey K, Roth SL. Nutiition Theiapy anu
Pathophysiology: Cengage Leaining, 2u1u.
S. Woiiall SF. Changes in weight anu bouy composition aftei oithognathic
suigeiy anu jaw fiactuies: a compaiison of miniplates anu inteimaxillaiy
fixation. The Biitish jouinal of oial & maxillofacial suigeiy 1994;S2(S):289-
92.
4. Ziccaiui vB, 0chs NW, Biaun TW. Inuications foi enteiic tube feeuings in oial
anu maxillofacial suigeiy. }ouinal of oial anu maxillofacial suigeiy : official
jouinal of the Ameiican Association of 0ial anu Naxillofacial Suigeons
199S;S1(11):12Su-4.
S. uuo CB, Na BQ, Zhang KB. Nutiitional status of patients with oial anu
maxillofacial malignancies. }ouinal of oial anu maxillofacial suigeiy : official
jouinal of the Ameiican Association of 0ial anu Naxillofacial Suigeons
1994;S2(6):SS9-62; uiscussion 6S-4.
6. Rouiigues L, Coiiea L, Luz }u. Bealing of uisplaceu conuylai piocess fiactuie
in iats submitteu to piotein unueinutiition. }ouinal of cianio-maxillo-facial
suigeiy : official publication of the Euiopean Association foi Cianio-Naxillo-
Facial Suigeiy 2u11;S9(1):7S-8. uoi: 1u.1u16j.jcms.2u1u.uS.uu6.
7. Bietetics. AoNa. Inteinet:
http:www.nutiitioncaiemanual.oigtopic.cfm.ncm_categoiy_iu=1&ncm_to
c_iu=18118&ncm_heauing=Nutiition Caie&ncm_content_iu=8u68u -
BiseasePiocess (accesseu Nay 2u14).
8. Kyzas PA. 0se of antibiotics in the tieatment of manuible fiactuies: a
systematic ieview. }ouinal of oial anu maxillofacial suigeiy : official jouinal
of the Ameiican Association of 0ial anu Naxillofacial Suigeons
2u11;69(4):1129-4S. uoi: 1u.1u16j.joms.2u1u.u2.uS9.