Mandible, nonunion refers to permanent failure of healing following a broken mandible usually caused by a fracture. May occur when the mandible moves too much during healing; has a poor blood supply or gets infected.

Inadequate reduction (alignment) or inadequate stabilization of a mandible fracture or both, are the most common causes of the condition. Factors that may adversely influence the healing (union) process are infection, advanced age, reduced blood supply to the area, poor nutrition, alcoholism, and poor patient compliance (cooperation).

Characteristic findings with nonunion are pain and mobility of the bone, at the site of the fracture after a normal period of expected healing (6 to 12 weeks). Malocclusion may also be evident, and there may be associated nutritional deficiencies and weight loss.

Physical examination for pain and abnormal mobility at the site of fracture are used to test for the condition. Plain radiographs or computed tomography (CT) scan or both show lack of bone healing and rounding of bone ends at the fracture site.

Treatment is directed at removing the cause of the poor healing. When infection is present, this may involve antibiotics and surgical debridement or drainage. Loose fixation appliances should be replaced by adequate stabilization. Bone grafting may be necessary. Nutritional counseling or dietary supplements or both may be needed.

Alternative methods of eating, inadequate nutritional status, pain, malocclusion and facial deformities may be long-term effects of the disorder. There may be abnormal formation of fibrous tissue (fibrous union) or pseudoarthrosis.

• None.

• For VA compensation purposes, diagnostic imaging studies include, but are not limited to, conventional radiography (X-ray), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), radionuclide bone scanning, or ultrasonography

• Separately evaluate loss of vocal articulation, loss of smell, loss of taste, neurological impairment, respiratory dysfunction, and other impairments under the appropriate diagnostic code and combine under 38 CFR 4.25 for each separately rated condition