Coleman Sign: A Hallmark For Mandibular Fracture? A Rare Case Exception
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 10, Pages 1064-1070
AbstractMandibular fracture involving the parasymphysis region is one of the most common fractures of mandible. Majority of parasymphysis fractures are due to direct blow or injury to the chin region. Specific signs and symptoms for parasymphysis fracture are pain, swelling, tenderness in the chin region, deranged occlusion, soft tissue injury to chin and the lower lip and sublingual hematoma. Frank Coleman considered a sublingual hematoma as “almost pathognomonic of fracture of the mandible”. We present a case that fails to replicate this hallmark sign associated with a mandibular fracture, as the patient had all the signs and symptoms of parasymphysis fracture except sublingual hematoma which is very rare and unusual to observe. The final diagnosis was made on the basis of radiographic examination using CBCT scan. On surgical exposure the mandibular parasymphysis fracture in the region of right lateral incisor and canine was confirmed. Such clinical scenario is very rare and unusual to observe. This case emphasizes on the fact that though Coleman sign has a very high specificity for mandibular fracture but it may not have high sensitivity. The examining doctor who completely relies on this sign and thus miss the fracture would be committing a gruesome mistake. In addition, this can lead to a risk of undermining a grievous hurt as that of a simple one which can result in medicolegal implication.
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