Mandibular fractures: an epidemiological survey at the Oral and Dental Hospital, Pretoria.

OBJECTIVE: The objective of this retrospective analysis was to study the etiology, distribution, treatment modalities and complications of mandibular fractures of patients who attended the Maxillo-Facial and Oral Surgery (MFOS) unit at the School of Dentistry, University of Pretoria. METHOD: The records of a representative sample of patients who presented at the MFOS unit with mandibular fractures between January 1999 and December 2003 were captured on a data form specifically designed for this purpose. The data were then analysed using the Statistix 8 programme. RESULTS: Of the 501 patients who were included in the survey, 67.6% were in the age group 21 to 40 years. The majority of the patients (83.2%) were male. Assault (72.5%) was the most common cause of injury followed by road traffic accidents (14.2 %) and falls (8.8%). Of the 501 cases, 41.3% were bilateral, 32.7% on the left side and 26% on the right side. With regard to the location of the fractures, the majority occurred in the body of the mandible (411%), followed by those in the area of the symphysis/ parasymphysis (23.1%). In the majority of cases (51.7%) the treatment modality used was a closed reduction with intermaxillary fixation. Complications were reported in 14.6% of the 501 cases of which malunion (32%) was the most prevalent. CONCLUSIONS: Mandibular fractures are more common in males in the age range 21 to 40 years. Interpersonal violence is the main cause of these fractures. The majority of mandibular fractures occur in the body region while malunion is the most common complication.     

Different patterns of mandibular fractures in children. An analysis of 220 fractures in 157 patients.

157 paediatric patients with a total of 220 mandibular fractures were evaluated retrospectively. All patients had been examined with the aid of orthopantomography. 72% of the children had fractures in the condylar region. The patients were divided into four age groups according to the development of the dentition (group A: 0-5 years, B: 6-9 years, C: 10-12 years, and D: 13-15 years). Bicycle accidents and falls were the two main causes of the fractures in all age groups. However, there were significant differences in the causes and location of the fractures between groups A+B and C+D. The proportion of condylar fractures decreased and the proportion of body and angle fractures increased with increasing age; fractures in the horizontal part of the mandible were mainly observed in groups C and D. Both aetiological factors and fracture patterns in the patients older than 10 years of age resembled those of adults. The differences observed should be taken into consideration in studies concerning mandibular fractures in paediatric patients. In this respect the age limit between the adult and child should probably be lowered significantly.     

Incidence and pattern of mandibular fractures in rural population: a review of 324 patients at a tertiary hospital in Loni, Maharashtra, India

Abstract –  The aim of this study was to document the pattern and incidence of mandibular fractures occurring in rural population, at Rural Dental College and Hospital, Maharashtra, India. A retrospective analysis of patient records and radiographs for the 5-year period from January 2003 to December 2007 was conducted. Data were identified and analyzed based on age group, gender distribution, anatomic location, and cause of injury. A total of 324 patients with 486 injuries were reviewed, males formed 80.9% and females 19.1% of the studied population, with peak incidence occurring in the 21–30 years age group. The most common fractures site was parasymphysis (39.3%). The etiology of mandibular fractures was road traffic accidents (42.9%), followed by falls (25.9%), assaults and interpersonal violence (20.7%), and animal injuries (10.5%). Our results exhibit that road traffic accidents remain the major cause of mandibular trauma and animal injuries being found exclusively in rural population. There is a variation of incidence and pattern of maxillofacial trauma from region to region.     

Complications in endoscopic-assisted open reduction and internal fixation of mandibular condyle fractures

Endoscopic-assisted open reduction and internal fixation (EAORIF) of subcondylar fractures is minimally invasive, provides excellent visibility without a large incision, and reduces surgical scarring and the risk of facial nerve injury. This study evaluated the complications associated with EAORIF. Twenty-six patients underwent EAORIF for mandibular condyle fractures. The postoperative follow-up period was longer than 6 months. We analyzed associations between the complication incidence and the number of fixation plates, accompanying mandibular fractures, and age. Eighteen (69.2%) and 6 (23.1%) patients had temporary (<3 months after surgery) and long-term (>6 months after surgery) complications, respectively. Patients older than 30 years had complications more frequently than those younger than 30 years. Complication rates were similar for different numbers of fixation plates and among patients with and without accompanying mandibular fractures. EAORIF is a reliable technique for treating condylar fractures, regardless of patient age, number of fixation plates, or accompanying mandibular fractures. However, improvements are needed to reduce long-term complications.     

Aetiology and incidence of maxillofacial trauma in Amsterdam: a retrospective analysis of 579 patients

INTRODUCTION: The incidence of maxillofacial fractures varies widely between different countries. The large variability in reported incidence and aetiology is due to a variety of contributing factors, including environmental, cultural and socioeconomic factors. This retrospective report presents a study investigating the aetiology and incidence of patients with maxillofacial fractures in Amsterdam over a period of 10 years. RESULTS: The study population consisted of 408 males and 171 females with a mean age of 35.9 (SD: ±16.3) years. The age group 20-29 years accounted for the largest subgroup in both sexes. The most common cause of the fractures was traffic related, followed by violence. There were mainly mandibular and zygomatic bone fractures in both males and females, accounting for approximately 80% of all fractures. The main fracture site of the mandible was the combination of mandibular body with mandibular condyle (66 patients; 26.8%), followed by the combination of bilateral condylar fracture and fracture of the symphysis (43 patients; 17.5%). In fractures of the upper 2/3 of the face, zygomatic bone fractures were most common. In patients with alcohol consumption the injury was mostly the result of violence. In conclusion, this report provides important data for the design of plans for injury prevention, as compared with previous studies. Violence related injuries are increasing whereas fractures caused by traffic accidents are decreasing.     

Prospective study on post-traumatic and postoperative sensory disturbances of the inferior alveolar nerve and infraorbital nerve in mandibular and midfacial fractures.

In a prospective study (January 1999 to December 1997), 34 patients with 26 mandibular and 20 midfacial fractures were investigated. All the fractures were managed by osteosynthesis. To evaluate the incidence and duration of recovery of post-traumatic and postoperative sensory disturbances, the following tests were carried out: sharp/blunt testing, and the two-point discrimination test as conventional clinical examination methods, and electromyographic recording of the masseter reflex to calibrate the clinical findings. To establish the sensory status of the inferior alveolar and the infraorbital nerves in the region of the fracture, and on the intact and control sides, the tests were performed pre-operatively and postoperatively on the seventh day, after 4 weeks and after 3, 6 and 12 months. The incidence of post-traumatic sensory disturbance was 46% for mandibular fractures and 65% for fractures to the midface (sharp/blunt test, two-point discrimination test). The rate of postoperative sensory disturbance in surgical treatment of mandibular fracture involving the region of the intra bony course of the inferior alveolar nerve, including the post-traumatic sensory disturbance, was 76.9%, and 55% following surgical treatment of midfacial fractures. The incidence of persistent sensory disturbances following surgical treatment was 7.7% in the case of mandibular fractures, and 15% in the case of midfacial fractures (sharp/blunt test, two-point discrimination test, masseter reflex). Recovery of neurological function is delayed in the presence of a displaced fracture (> 1 mm) as compared with non-displaced fractures. For the postoperative calibration of sensory disturbances, electromyographic recording of the masseter reflex from the fourth postoperative week onwards has proved useful.     

Mandibular trauma treatment: A comparison of two protocols

Objectives: The aim of this study was to evaluate the treatment of mandibular fractures treated in two European centre in 10 years. Study Design: This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures in two centers in Turin, Italy and in Amsterdam, the Netherlands for ten years. Only patients who were admitted for mandibular fractures were considered for this study. Results: Between 2001 and 2010, a total of 752 patients were admitted at Turin hospital with a total of 1167 mandibular fractures not associated with further maxillofacial fractures, whereas 245 patients were admitted at Amsterdam hospital with a total of 434 mandibular fractures. At Amsterdam center, a total of 457 plates (1.5 - 2.7 mm) were used for the 434 mandibular fracture lines, whereas at Turin center 1232 plates (1.5 – 2.5 mm) were used for the management of the 1167 mandibular fracture lines. At Turin center, 190 patients were treated primarily with IMF, whereas 35 patients were treated with such treatment option at Amsterdam center. Conclusions: Current protocols for the management of mandibular fractures are quite efficient. It is difficult to obtain a uniform protocol, because of the difference of course of each occurring fracture and because of surgeons’ experiences and preferences. Several techniques can still be used for each peculiar fracture of the mandible. Key words:Mandibular fracture, facial trauma, maxillofacial, treatment, multicentre, database.     

Review of maxillofacial injuries in Chennai, India: a study of 2748 cases

We reviewed the medical records of 2748 patients treated for maxillofacial injuries at Sri Ramachandra Medical and Dental College and Hospital between January 1999 and December 2005. 1332 (42%) had soft tissue injuries, 1176 (37%) had mid face fractures, and 512 (16%) had mandibular fractures. Most patients with midface fractures had fractures of the zygomaticomaxillary region 422 (36%), while fractures of the parasymphyseal region were more common in the mandible 156 (31%). Most patients were in the 21-30 year-old age group, and the male:female ratio was 3.7:1. Road crashes, particularly involving motorcycles, accounted for 1710 (62%), with a high prevalence during the month of September and on Saturdays.     

Pattern of paediatric maxillofacial fractures in Lagos, Nigeria

BACKGROUND: Maxillofacial fractures in children are rare when compared to those occurring in adults. To establish the incidence, pattern, and aetiology of maxillofacial fractures in children aged 15 years and below in Lagos, Nigeria. DESIGN: A review of patients with maxillofacial fractures aged 15 years and below seen and treated at the Lagos University Teaching Hospital, Lagos, Nigeria between January 1997 and December 2004 was conducted. RESULTS: Of the 225 patients with maxillofacial fractures seen within the study period, 37 (16.4%) were children aged 15 years and below, with a male-to-female ratio of 1.5 : 1. The highest incidence recorded was found within the age group 12-15 years (41%), with the lowest incidence occurring in the age group 0-5 years (27%). Multiple fractures were commoner in older patients (P > 0.05), and in boys (P > 0.05). There were no statistically significant relationships between the age of the patients, gender distribution, and mechanisms of injury. Road traffic crashes were the most common aetiological factor (64.9%), with the mandible being the most involved facial bone (63.8%). Majority of the mandibular fractures (33.3%) were located in parasymphyseal region. Zygomatic complex fractures were the most common in the mid-facial region. Most of the fractures (81.1%) were immobilized by simple methods (arch bars, eyelet wires, acrylic splint with circum-mandibular wiring) with or without intermaxillary fixation. Of the cases, 18.9% were managed conservatively. CONCLUSION: The incidence of facial fractures in this study was found to be higher than previously reported in Nigeria and worldwide, with almost two-thirds of cases a result of road traffic crashes. There is a need to enforce legislation aimed at preventing road traffic crashes to reduce maxillofacial injuries in children.     

Mandibular fractures in Jordanians: a comparative study between young and adult patients.

BACKGROUND: There are very few reports directly comparing mandibular fractures between young and adult patients in Middle Eastern countries. AIM: To review and compare the frequency and aetiology of mandibular fractures in young and adult Jordanian patients. STUDY DESIGN: A retrospective review was made of patients' records and radiographs seen at two university-based maxillofacial units during a 10-year period between 1993 and 2002. Age, gender, aetiology, and site were analysed and compared between young and adult patients. RESULTS: In total, 703 patients (502 (71%) male and 201 (29%) female) were found with 892 mandibular fractures altogether. There were 497 (71%) adults with 676 fractures, and 206 (29%) young patients with 216 fractures. The mean age of the adults was 30 years with a male-to-female ratio of 2.5:1. The mean age of the young patients was 13 years with a male-to-female ratio of 1.5:1. The most common fracture site in adult patients was the mandibular body, whereas the condyle predominated in young patients. The most common causative factor in adults was road traffic accidents, and falls in the young. CONCLUSION: There was a similar gender distribution in both groups of Jordanian young and adult patients. However, there were differences regarding aetiology and site of fracture. The differences found in this study between adult and young patients are similar to those from other countries.     

Immediate and late mandibular fractures after third molar removal.

PURPOSE: In this retrospective study, we analyzed immediate and late mandibular fractures after impacted lower third molar surgery. PATIENTS AND METHODS: One hundred fifty oral and maxillofacial surgeons in the north of- France were questioned about their experience with intraoperative and late mandibular fracture after third molar surgery. Cases were examined clinically and radiographically. RESULTS: Thirty-seven fractures were reported in about 750,000 extractions (incidence of 0.0049%). Only 27 cases could be precisely described: 17 intraoperative and 10 late fractures. The patients were 19 to 75 years of age, with an average age of 37 years for intraoperative fractures and 47 years for late fractures. All grades of tooth impaction were included. Only 2 patients did not have full dentition. CONCLUSIONS: The major incidence of immediate and late mandible fractures occurs in patients older than over 25 years. Men may be more likely to have late fractures (8 of 10 cases).     

Relationship between the risk of mandibular angle fractures and the status of incompletely erupted mandibular third molars.

BACK GROUND: Several studies have shown the increased risk of mandibular angle fractures associated with incompletely erupted mandibular third molars. But only a few reports analysed in detail the relationship of the status of eruption of this tooth and this type of fracture. OBJECTIVES: The purpose of this study was to clarify the influence of the eruption status of incompletely erupted mandibular third molars on the incidence of mandibular angle fractures. METHODS: Four hundred and thirty-six mandibular halves in 218 patients with mandibular fractures, aged between 15 and 40 years old, were analysed using panoramic radiographs. RESULTS: The incidence of angle fractures in the mandibular halves with incompletely erupted mandibular third molars was 30.8% and this was statistically significantly higher than that in another group (p<0.0001). Deeply located mandibular third molars clearly showed a higher incidence of this fracture when compared with the adjacent second molar (p<0.0001). CONCLUSION: The results of this investigation showed that incompletely erupted mandibular third molars close to the inferior border of the mandible have a high risk of angle fractures.     

Trends of maxillofacial and mandibular fractures in level I and II trauma patients in a tertiary hospital in Saudi Arabia

BackgroundMaxillofacial injury is a major health concern worldwide. Incidence of maxillofacial fractures is influenced by socio-demographic, economic, and cultural factor of the population investigated. Identifying the patterns of these fractures is crucial to establish effective treatments and prevention measures. The aim of the study was to to analyze the incidence, etiology, and types of maxillofacial fractures in a tertiary trauma center.MethodsA retrospective analysis was conducted for all patients who were admitted with maxillofacial fractures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. A total of of 422 patients with 978 maxillofacial fractures were enrolled over a 4-year period.ResultsAmong the 422 patients, 387 (91.8%) were males, and 35 (8.2%) were females. The mean age of our population was 31.1 years old. Our study has shown that motor vehicle accidents are the leading cause of maxillofacial fractures, followed by pedestrian trauma. The most common maxillofacial fractures were orbital fractures, followed by maxillary fractures. The mandibular body was most fractured among mandibular fractures. Our data has shown that males have higher incidence of maxillofacial fractures than females.ConclusionOur study further validated that road traffic accidents are the most common cause of maxillofacial fractures in our region. These findings emphasized the importance of improving road safety protocols and enforcing traffic laws.     

Review of 509 mandibular fractures treated at the University Hospital, Alexandria, Egypt

Mandibular fracture is one of the most common facial skeletal injuries. Although its main causes are road crashes and violence, the relation between these causes varies from one country to another. We made a retrospective study of the medical records and radiographs of 509 patients treated for mandibular fracture at the University of Alexandria Hospital between 1991 and 2000. The data that we collected included age, sex, aetiology, date of injury, anatomical site of the fracture, associated maxillofacial trauma, and treatment. The prevalence of mandibular fractures was higher in male subjects in all age groups, and the male:female ratio was 3.6:1. Most fractures were sustained by men in the age group 21-30 years and girls between 0 and 10 years, and the monthly incidence was constant. Road crashes were the main cause, followed by falls and assaults. Fractures of the angle were the most common (22%) followed by parasymphyseal fractures (21%) and the lowest was in the coronoid region (1%).     

Fractures of the facial skeleton in Reykjavik, Iceland, 1970-1979. (I) Mandibular fracture in 238 hospitalized patients, 1970-79

Almost all facial fracture surgery in Iceland is performed in the hospitals in Reykjavik. Some information about the treatment of facial fractures at the City Hospital was published in the Icelandic Medical Journal in 1978. Apparently, no other research on facial fractures has been done here. This article, therefore, deals with 238 patients who sustained mandibular fracture in 1970-79. There was a marked increase in the incidence of fracture of the mandible during the research period, especially in 1974 and 1975. The total of fractures in women, 33%, was higher than in other countries. Assault was a major factor for both sexes. Especially interesting was the fact that beating and assault accounted for 46% of all mandibular fractures in women. Multiple fractures from beatings were commoner here in Iceland than in other countries. For the group as a whole, 52% of the patients had multiple fractures of the mandible. The incidence of fractures among those between 16 and 20 years of age was proportionately higher here than elsewhere due to car accidents and assault and battery. The types of fracture and area of occurrence in the mandible varied with the cause. Fractures of the corpus and angulus mandibulae were proportionately common, both because of the number of assault cases and also because the proportion of those who were edentulous, 19%, was higher than in other countries. Among the young, fracture of the processus condylaris was commonest, and up to age 30, when fracture of the corpus mandibulae was more likely. Fracture of the processus coronoideus never occurred alone. In all cases, it was accompanied by a fracture in another area of the mandible or zygomatic fracture, and this result is in accordance with the idea that the processus coronoideus almost never breaks alone, because of its location, its strength, and the attachment of the muscles.     

Pattern of mandibular fractures in an urban major trauma center.

PURPOSE: Many studies focusing on the pattern of presentation of mandibular fractures are inconclusive. This is largely due to a multifactorial involvement of associated factors and the role of anatomic factors. Patients and Methods: We reviewed a 10-year retrospective analysis of the pattern of presentation of mandibular fractures at an urban level I trauma center in Washington, DC, and the significance of the variables in association with the fractures. These include mechanism of action, age group, illicit drug use, seasonal variation, and the incidence of multiple fracture sites. We also looked at the evolving pattern of mandibular fractures in comparison to an earlier study conducted in the 1960s at the same hospital. Data collection was done through the use of medical records and all documented radiographs. Variables that were analyzed in association with the fractures include age, gender, mechanism of action, seasonal variation, and anatomic location. Data analysis was done using subjective analysis, frequency distribution, and multiple regression tests, where appropriate. RESULTS: Data analysis shows that 86% of all fracture patients are male, and 37% of all patients were in the 25- to 34-year-old age group. Use of an illicit substance at the time of trauma was seen in 55% of all cases. Interpersonal violence accounted for 79% of all patients, with prevalence in the summer (31%) and winter (28%) months. The most common location of fracture is in the angle region (36%), followed by the body (21%) and parasympyhseal region (17%), with 52% presenting with more than one fracture site. CONCLUSION: The evolving pattern of fractures in urban trauma centers is showing an increasing trend of association with illicit substances and interpersonal violence as a major causative factor.     

Frequency and type of dental traumas in mandibular body and condyle fractures

Abstract Dental injuries in association with 207 mandibular fractures were evaluated from patient files and radiographs. It was shown that 32% of the dentulous patients with condylar fractures had dental injuries, approximately 3.7 traumatised teeth per patient, most of which were dental hard tissue injuries and situated typically in the maxillary molar region. Dental injuries were diagnosed in 30% in association with mandibular corpus fractures, approximately 3.6 traumatised teeth per patient, and injuries were more often dental luxations in the anterior part of the mandible. It was found that 143 teeth were involved in the line of mandibular corpus fracture of 105 patients (1.4 per patient). More than half of the fracture lines were diagnosed as passing the periodontal ligament.     

Frequency and type of dental traumas in mandibular body and condyle fractures.

Dental injuries in association with 207 mandibular fractures were evaluated from patient files and radiographs. It was shown that 32% of the dentulous patients with condylar fractures had dental injuries, approximately 3.7 traumatised teeth per patient, most of which were dental hard tissue injuries and situated typically in the maxillary molar region. Dental injuries were diagnosed in 30% in association with mandibular corpus fractures, approximately 3.6 traumatised teeth per patient, and injuries were more often dental luxations in the anterior part of the mandible. It was found that 143 teeth were involved in the line of mandibular corpus fracture of 105 patients (1.4 per patient). More than half of the fracture lines were diagnosed as passing the periodontal ligament.     

Fractures of the mandibular condyle. Part 1: patterns of distribution of types and causes of fractures in 348 patients

This prospective study was designed to record relevant characteristics of mandibular condyle fractures and to evaluate the relationship between these. Data were recorded on sex, age, cause of trauma, level of fracture, dislocation of the mandibular head, dental state and associated fractures of all patients diagnosed in our hospital during the period 1984-1996 with mandibular condyle fractures. Data were analysed in our Computer Department.The sample comprised 348 patients with 444 fractures, and a male:female ratio of 2:1. Traffic accidents were the most common cause: 103 (41%) of the unilateral and 54 (56%) of the bilateral fractures, followed by alleged assault and falls. Low fractures were the most common -n = 314 of 444 (71%).The causes that involved considerable force (traffic accidents and falls) resulted in more dislocations of the mandibular head, more bilateral fractures, a tendency to fractures higher on the condyle and significantly more intracapsular fractures. Absence of molar occlusion also gave more high and fewer low fractures, but played no part in dislocation of the mandibular head from the glenoid fossa.