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The utility of the tongue blade test for the diagnosis of mandibular fracture
  1. Rashmi Malhotra, Medical Student,
  2. Joel Dunning, RCS Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether the tongue blade test is useful in the clinical assessment of patients with mandibular trauma. Altogether 269 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Rashmi Malhotra, Medical Student
 Checked by Joel Dunning, RCS Research Fellow

    Clinical scenario

    You are evaluating a patient who has attended the emergency department having just been punched on the jaw. He is having difficulty opening his mouth and talking but you can see no step deformity or loose teeth. You recall that while you were on elective you saw the tongue blade test being used routinely in America to select patients for mandibular imaging. For this test the patient is asked to bite on the tongue blade and if the examiner can break the blade while the patient grips it, the patient does not need a mandibular radiograph. You wonder whether this is a sensitive test to use in this patient.

    Three part question

    In [patients with mandibular trauma] is [the tongue blade test] a good diagnostic test for [mandibular fracture]?

    Search strategy

    Medline 1966-7/03 using the OVID interface. [(mandibular fracture.mp.OR exp Mandibular Fractures/) OR {(exp fractures OR fracture$.mp) AND (exp mandible OR mandible$.mp or mandibular.mp)}] AND exp diagnosis OR diagnosis.mp AND maximally sensitive RCT filter LIMIT to human AND English.

    Search outcome

    Altogether 269 papers were found of which two were relevant and are listed in table 6.

    Table 6

    Comment(s)

    No confidence intervals were calculated by Roberts et al for the reported sensitivity of the tongue blade test so we calculated this ourselves: sensitivity 95.4% (CI 84.53% to 99.44%). The confidence intervals are comparatively wide and so the tongue blade test could not stand on its own as a single diagnostic tool in screening for mandibular fractures since missing these fractures can lead to serious long term complications.

    The high sensitivities reported by both these studies do suggest, however, that the tongue blade test is a useful screening tool in evaluating patients with mandibular fracture but other clinical predictors must also be considered.

    CLINICAL BOTTOM LINE

    The tongue blade test is useful in evaluating patients with possible mandibular fracture

    Report by Rashmi Malhotra, Medical Student
 Checked by Joel Dunning, RCS Research Fellow

    References

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