A Jaw Crushing Line Drive in a Baseball Pitcher

Abstract

TITLE: A Jaw Crushing Line Drive in a Baseball Pitcher AUTHORS: Joshua Wilner, MD, Michael Fong, MD (Sponsor: Aaron Rubin, FACSM) INSTITUTIONS: Kaiser Permanente Los Angeles HISTORY: A 23 year old collegiate baseball pitcher sustained a line drive off the right body of his mandible. The patient had a few seconds in which he reported loss of consciousness. After regaining consciousness, he found the baseball at his feet and threw to first in time for the out. At initial medical evaluation, patient complained of pain and bleeding at the right body of his mandible where the baseball made struck him. However, the site of maximal pain was the left superior mandible, where there was no direct trauma. The patient also had concussion symptoms, including headache, confusion, and photophobia. PHYSICAL EXAMINATION: Examination on the field indicated a superficial laceration over the right body of the mandible. There was tenderness and swelling at the right body and left subcondylar aspect of the mandible. He had trismus, but no dysphagia or malocclusion. Patient had a positive concussion evaluation. There was no dental or oral trauma. There was no airway compromise or cervical spine abnormalities. There were no neurological deficits. The patient was sent to the emergency room for further evaluation and imaging. DIFFERENTIAL DIAGNOSIS: 1. Mandible fracture 2. Mandible contusion 3. Mandible dislocation TEST AND RESULTS: CT Scan Head and Mandible: 1. Non-displaced left subcondylar mandible fracture 2. No fracture of right body of mandible 3. No acute intracranial hemorrhage or pathology FINAL DIAGNOSES: Non-displaced, closed left subcondylar mandible fracture Concussion Facial laceration TREATMENT AND OUTCOMES: 1. Mandible fracture was treated with observation and soft diet for 4 weeks. 2. All concussion symptoms resolved within 4 days, and the patient graduated return to play protocol. 3. The laceration was treated with simple interrupted suture repair for 7 days. There were no wound complications. 4. The patient returned to full baseball activities 4 weeks after date of initial injury.