An epidemiological study on pattern and incidence of mandibular fractures

A Single Center Experience: A Retrospective Study Over 10-Years Period on Mandible Fractures

Study Design

The purpose of this study was to do a retrospective analysis about patients with mandibular fracture who were treated at the department of Maxillofacial Surgery, Regional University Hospital of Ancona, Italy, between 2011 and 2021.

Objective

In this study we evaluated clinical and epidemiological findings of mandible fractures focusing on the association between surgical timing, type of surgical approach and mid- and long-term outcomes.

Methods

Patients were evaluated based on various parameters including age, sex, etiology, symptoms, comorbidity, clinical findings, mandible fracture type, other facial fractures, treatment, waiting time before the operation, complications and sequelae. In the period described, we recorded 1023 mandibular fractures. 93% of patients underwent surgery under general anesthesia, almost exclusively patients undergoing an open approach to internal fixation.

Results

Of the patients, 684 were male (66.86%) and 339 were female (33.13%). The average age of the patients was 42, 38 years (range, 7-94 years). The leading cause of these fractures was traffic accidents (27.3%) and mandibular parasymphysis fractures were the most frequent (34.1%). The most common clinical signs and symptoms were malocclusion, difficulty in chewing, limitation of the buccal opening, hypoesthesia extending through the territory of the inferior alveolar nerve, difficulty in protrusion movements and mandibular lateralization.

Conclusions

The continuous research in epidemiology, etiology, materials, and techniques will further refine the treatments of mandible fractures, which are nowadays more and more customized according to the type of trauma.

Evaluation of Efficacy of Herbert Bone Screw and Lag Screw in Management of Oblique Mandibular Fractures: A Prospective Randomized Comparative Study

Purpose

To assess the efficacy of Herbert cannulated bone screw versus Lag screw in fixation of oblique mandibular fractures.

Materials and Method

Study composed of two groups of 20 patients each and descriptive statistics were performed with p value set at 0.05 with confidence interval of 95%. Group A was treated by Titanium Lag screws; while, Group B was treated by Titanium Herbert Cannulated Bone Screws for the management of oblique mandibular fractures. Postoperatively, all the patients were evaluated clinically and radiographically by recording the incidence of complications (if any) which included trismus, neurosensory deficit, swelling, infection. Parameters such as occlusal discrepancy, rigid fixation (interfragmentary gap) and duration of surgery were also recorded for all the patients.

Results

All the patients were followed for a period of three months. Difference in mouth opening was found to be statistically significant during 1st month follow-up (p-Value-0.002). Postoperatively, the mean interfragmentary gap in Group A was significantly more than Group B (p-Value-0.000). Other parameters like neurosensory deficits, occlusal discrepancies, chewing efficiency, stability of fractured fragments and post-operative complications in terms of swelling, hardware exposure, radiolucency surrounding screw and wound dehiscence did not show any statistically significant difference.

Conclusion

The obtained results showed that both lag screws and Herbert cannulated bone screws fulfill the treatment goals of adequate reduction, fixation and stabilization of oblique mandibular fractures. Herbert screws have shown to have better results in terms of interfragmentary gap reduction as compared to lag screws.

Comparison of Patterns and Demographics of Isolated Traumatic Mandibular Fracture Between Incarcerated and General Populations

Introduction The management of maxillofacial trauma can be challenging in different unique clinical presentations. While maxillofacial fractures vary in location based on the mechanism of injury, the mandibular fracture is noted to be one of the most common facial fractures. The objective of this study was to explore the differences in injury patterns, outcomes, and demographics of isolated traumatic mandibular fractures between incarcerated and general populations. Methods This retrospective study analyzed consecutive patients presenting for trauma care from January 1, 2010, to December 31, 2020, at the Arrowhead Regional Medical Center (ARMC). Patients 18 years and older were included in this study. Patients diagnosed with mandibular fracture as the primary diagnosis at admission and discharge were identified using the International Classification of Disease, Ninth and Tenth Revision (ICD-9, ICD-10) Code. Patient demographics were extracted from their electronic medical records and included race, marital status, and insurance status. Results A total of 1080 patients with confirmed mandibular fractures were included in the final analysis. Among these patients, 87.5% (n=945) were males, 40% (n=432) of the patients were Hispanic, and the average age was 31.55 years old. The most common mechanism of injury was blunt trauma secondary to assault. Compared to the general population with mandibular fracture, the incarcerated patients with mandibular fracture were more likely to be males (96.1% vs 86.1% for incarcerated population vs. general population respectively, p=0.0005). No other variables were statistically different between these two groups. Conclusion The evidence from this study suggests that the patterns, outcomes, and demographics of mandibular fracture in both incarcerated and general populations are similar.

A Changing Trend in Pattern of Maxillofacial Trauma in Mumbai: A Prospective Study

INTRODUCTION

Maxillofacial skeleton is the most vulnerable site for trauma due to its prominence. The aim of our study was to analyse the cause and pattern of maxillofacial injuries & to correlate the aetiology and pattern of facial injury.

MATERIALS AND METHODS

This prospective study includes 304 patients with facial trauma, who reported to our institute within a time span of 2 years. Data were collected on basis of sociodemographic status plus additional data obtained on type of injury, aetiology, location and status of the victim.

RESULT

The most frequent cause of maxillofacial trauma (MFT) was fall (43.3%) followed by RTA (34.2%) and assault (15.1%). In upper 3rd face region frontal bone fracture was prevalent with 1.3%, while in the midface, zygomatic complex (ZMC) fracture (3.9%) and in lower 3rd part of face, mandible fracture (42.8%) and dentoalveolar fracture (30.2%). Mandible was the most prevalent site for trauma. Although fall was the main aetiological factor in our study, midfacial injuries were mainly due to assault and RTA. Combination of mandibular fracture and soft tissue injury were mainly seen in RTA and injury due to fall. Conservative management was mainly employed for treatment with 46.1% followed by ORIF with 36.2%.

CONCLUSION

Changing trend in aetiology of MFT was noted. Furthermore, study should be conducted for better understanding, and to carry out preventive measure for the same.

Incidence and Management of Tooth Root Fracture in Mandibular Fracture Line - A Retrospective Study

Introduction

In cases of trauma, the most common fractures of the facial region are the nasal bone fractures followed by mandibular fractures. About 60% of mandible fractures are associated with teeth in the fracture line; however conversely, the dentulous mandible has a higher susceptibility of fracture in any impact. Whenever a tooth is involved in the fracture line, it is not unlikely that the tooth root fracture will be associated with it. The prognosis and treatment of such a tooth persistent in a fracture line depends upon the level of tooth root fracture.

Materials and Methods

This retrospective study was conducted in the Department of Oral and Maxillofacial Surgery in a Meerut hospital. The eligibility criteria were based on the cases involving fracture line passing through the teeth bearing area of mandible. Total of 56 cases of mandibular fracture treated from January 2021 till December 2022 by open reduction and fixation were included in the study.

Results

A total of 56 patients (66 fracture lines) with mandibular fractures were selected, out of which 18 (32%) patients had fracture of the root of the tooth in the fracture line. Third molar root fracture were present in 12 cases (66.6%), first premolars in 4 cases (22.2%), and first molars in 2 cases (11.1%). There were 14 multi rooted teeth (77.7%) and 4 single rooted teeth (22.2%) involvement. All the multi rooted teeth fracture were treated by extraction during open reduction and fracture fixation. The single rooted teeth were successfully treated by endodontic treatment postoperatively.

Discussion

The fracture line passing through the dentate segment may fracture the tooth crown and/or root or propagate through the socket without any injury to the root. Root fracture at cervical and middle third is constantly exposed to oral fluids. The affected tooth may be mobile and lose vitality. Teeth in the line of fracture must be removed when they preclude the correct reduction of the segments or if they represent a risk for infection. If the tooth or root does not cause any hindrance during reduction or it is not infected, the tooth can be salvaged by endodontic therapy. The incidence of root fracture was seen in 32% of cases. Fracture of the third molar roots was the single largest group (66.6%). No root fracture was observed in the anterior segment.

Classification of unusual fracture patterns of the mandible: A retrospective study

The aim of this study is to devise and summarize a classification of fracture patterns involving multiple anatomical sites of the mandible. A retrospective study was conducted by reviewing clinical case records, imaging records, and the surgical management of patients presenting with mandibular fracture. Demographic data were collected and causes of the fractures were studied. Following radiological evaluations based on the courses of fracture lines, these fractures were categorized into three components: horizontal (H), vertical (V), and sagittal (S). In case of horizontal components, the mandibular canal was used as a reference. For vertical components, the fracture lines were classified according to where they terminated. With sagittal components, the direction of the bicortical split at the base of mandible was used as a reference. Out of a total of 893 mandibular trauma patients, 30 unusual fractures were identified (21 in males and nine in females), which do not fit into existing classifications. These were mainly due to road traffic accidents. Horizontal components of fractures were classified as H-I, H-II, and H-III, and vertical components as V-I, V-II, and V-III. For sagittal components, two types were identified - S-I and S-II - resulting in a bicortical split of the mandible. This classification is proposed to help understanding the complex fractures and to allow standardized communication among clinicians. Moreover, it is designed in such a way that aids in the choice of fixation technique. Further studies are needed to establish standardized treatment algorithms for efficient management of these unusual fractures.

Retrospective clinical study of mandible fractures

Background

As society becomes more complex, the incidence of mandibular fractures is increasing. This study aimed to analyze the incidence and type and identify etiological factors of mandibular fractures to use them in future treatments.

Material and methods

Data were collected from 224 patients who visited the department of oral and maxillofacial surgery at the Kyung Hee Medical Center dental hospital during a 6-year period (2016 to 2021). A logistic regression model was used for data analysis.

Results

In a total of 224 patients, 362 fractures were appeared. The average age of the patients was 34.1 years, with the highest incidence in the 20s. And the ratio between male and female was 4.09:1. Symphysis fractures were the most prevalent of all patients (52.7%), followed by unilateral condyle (37.1%), angle (36.2%), bilateral condyle (9.4%), body (8%), and coronoid (2.2%). The most common cause of fracture was daily-life activity (57.6%), followed by violence (30.4%), traffic accidents (8.5%), and syncope (3.6%). Patients with symphysis fracture were at low risk (OR < 1) of angle, body, and unilateral condyle fractures. Similarly, patients with unilateral fracture were at low risk (OR < 1) of symphysis, angle, body, and others site fractures. In contrast, patient with bilateral condyle fracture were at high risk (OR > 1) of coronoid fractures. And younger patients were high risk of mandibular angle fractures.

Conclusion

Through this study, it was confirmed that etiological factors of mandibular fractures were like those of previous studies.

One miniplate versus two miniplates in the fixation of mandibular angle fractures. An updated systematic review and meta-analysis

PURPOSE

The aim of this study is to compare the outcomes after using one miniplate fixation in the external oblique ridge versus two miniplate fixation for mandibular angle fractures.

METHODS

A systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database was performed (last search date: 04 February 2022) according to the PRISMA guidelines. The research question was addressed using the PICO criteria. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed.

RESULTS

Seventeen studies, comprising a total of 1667 patients, 846 undergoing one miniplate fixation and 854 undergoing two miniplate fixation for mandibular angle fractures were identified. No statistically significant differences were observed regarding surgical site infection (odds ratio [OR]= 0.94, 95% confidence interval [CI]: [0.69] - [1.28], p = 0.68, I²=0.00%), post-operative malocclusion (OR= 0.97, 95% CI: [0.53] - [1.18], p = 0.25, I²=0.00%), post-operative neurosensory dysfunction (OR= 0.67, 95% CI: [0.37] - [1.22], p = 0.19, I²=73.93%), pseudoarthrosis formation (OR=0.90, 95% CI: [0.58] - [(1.39], p = 0.63, I²=0.00%). Wound dehiscence was marginally less common in the one miniplate group (OR=0.52, 95% CI: [0.28] - [0.98], p = 0.04, I²=54.34%). The probability of scarring formation (OR=0.13, 95% CI: [0.05] - [0.32], p = 0.00, I²=0.00%) and hardware failure (OR=0.36, 95% CI [0.21] - [0.62], p = 0.00, I²=29.33%) were statistically significantly higher in the two miniplates arm.

CONCLUSION

One miniplate fixation and two miniplates fixation of mandibular angle fractures have similar results regarding post operative infection, malocclusion, neurosensory dysfunction and pseudoarthrosis formation while wound dehiscence, hardware failure and scarring seem to be more common when two miniplates are used as a fixation technique.

Incidence and management of mandibular fractures in a low-resource health facility in Ghana

Objectives

The mandible and other parts of the maxillofacial region suffer significant morbid injuries following road traffic accidents. Our study gives epidemiological description of mandibular fractures in Ghana and also evaluates the relevance of closed reduction and indirect fixation for managing mandibular fractures in low-resource health facilities in low-income countries like Ghana.

Patients and Methods This is a retrospective study involving 268 patients who reported to the Department of Oral and Maxillofacial Surgery of the Sunyani Regional Hospital with mandibular fractures from January 2010 to December 2019. Patient medical records were assessed for information on age, sex, fracture etiology, anatomic location of fracture, time of day of road traffic accident, and other associated injuries.

Results

A total of 268 patients were included in this study (males, 216 [80.6%]; females, 52 [19.4%]). Motor vehicular accident (MVA) was the leading cause of mandibular fractures (202 injuries, 75.4%). Other etiologies included assault (39, 14.6%), gunshot (13, 4.9%), falls (12, 4.5%), and industrial accidents (2, 0.7%). Of the 161 male cases caused by MVA, 121 (75.2%) occurred at night and in the evening while the remaining 40 (24.8%) occurred in the morning and afternoon. Among all managed 222 patients, 212 (79.1%) were treated with closed reduction and indirect fixation technique while 10 (3.7%) were treated with open reduction and direct fixation.

Conclusion

Closed reduction with indirect fixation could successfully be used to manage mandibular fractures in low resourced health facilities, especially in low-income countries. The poor lightening system on roads in Ghana is a major contributory factor to motor vehicular accidents.

Minimally Invasive "Trocar-Free" Approach for Rear Mandibular Fractures Management

ABSTRACT

The request of minimally invasive surgery is progressively expanding the indications of endoscopically assisted intraoral access for mandibular traumas. The aim of our study is to assess how much the use of the angled drill may affect the outcome of patients treated for rear mandibular fracture.In our retrospective case-control trial we enrolled 36 patients with mandibular rear fractures treated through endoscopically assisted intraoral access. Eighteen patients were treated by using an angled drill "trocar free," and 18 treated by linear drills placed through trocars. Surgical times, hospitalization times (HT), and major complications rate were compared between the 2 groups.Group 1 showed a significant reduction in HT (1.72 versus 2.22 days, P = 0.024) and an increase in the surgical times (3.0 versus 2.53 hours, P = 0.019). Significant reduction of total amount of complication was seen in group 1 versus group 2 (P = 0.007).The "trocar free" approach allowed by angled drills, in our hands, greatly reduces the invasiveness of the surgery resulting in a significant reduction in HT and smaller share of vascular-nervous sequelae. Our results suggest the "trocar free" approach as a valuable choice when indicated for the treatment of rear mandibular fractures.

A retrospective analysis of mandibular fractures in Mewat, India

Objectives

Mandibular fractures vary significantly with respect to epidemiological and demographic parameters among populations. To date, no study has evaluated these aspects of mandibular fractures in Nuh, Mewat, Haryana, India. To retrospectively analyze the incidence, age and sex distributions, etiology, anatomic distribution, occlusal status, treatment modality provided, and their correlation in patients who suffered isolated mandibular fractures.

Materials and Methods

The records of maxillofacial injury patients who reported to the Department of Dentistry, SHKM Government Medical College from January 2013 to December 2019, were retrieved from our database, and necessary information was collected. The data collected were analyzed statistically using IBM SPSS ver. 21.

Results

Totals of 146 patients and 211 fractures were analyzed. There were 127 males and 19 females with an age range of 3-70 years (mean age, 26 years). Road traffic accident (RTA) was the most common cause of fracture (64.4%), followed by fall (19.9%), assault (15.1%), and sports injury (0.7%). Of all patients, 42.5% had bilateral fractures, 31.5% had left side fracture, 21.2% had right side fracture, 3.4% sustained midline symphyseal fracture, and 1.4% had symphyseal fracture along one side of the mandible. Site distribution was as follows parasymphysis (34.6%), angle (23.7%), condyle (20.4%), body (12.8%), symphysis (4.3%), ramus 2.4%, and dentoalveolar 1.9%. The most common facture combination was angle with parasymphysis (17.8%). Occlusion was disrupted in 69.2% patients. Closed reduction was the predominant treatment modality.

Conclusion

The data obtained from retrospective analyses of maxillofacial trauma increase the understanding of variables and their outcomes among populations. The results of the present study are comparable to those of the literature in some aspects and different in others.

An epidemiological analysis of maxillofacial fractures: a 10-year cross-sectional cohort retrospective study of 1007 patients

Background

Epidemiological data is providing vital indicators for organizing the financial resources related to a particular type of trauma, estimating expenses and training of dental practioners and ambulatory medical staff for collaboration with a certain pattern of patients. Knowing the etiology and epidemiology of a certain pathology is significant for approaching its means of prevention.

Methods

A 10-year retrospective statistical analysis of 1007 patients with maxillofacial fractures treated in a University Clinic of Oral and Maxillofacial Surgery in Romania was performed. The data were extracted from patients’ medical records. Statistical analysis was performed. A value of p < 0.05 was considered statistically significant.

Results

The incidence of maxillofacial fractures was high among patients in the 20–29 age group (35.9%). Male patients (90.57%, M:F = 9.6:1), having a low level of education (46.60%) and living in urban areas (53.50%) were more affected. The main cause of maxillofacial fractures was interpersonal violence (59.37%), both in the mandibular and midface topographic regions (p = 0.001, p = 0.002). In urban areas, fractures caused by interpersonal violence and road traffic accidents were predominant, while in rural areas, most of the fractures were due to interpersonal violence, domestic accidents, work accidents and animal attacks (p = 0.001).

Conclusions

Interpersonal violence is the main cause of maxillofacial fractures having epidemic proportions. Male patients aged 20–29 years with a low level of education represent the major risk category. Considering the wide area of interpersonal aggression, both the medical staff in the hospital and in the dental offices must be educated in order to collaborate with possible violent patients. Dentists must be prepared to work on a post-traumatic dento-periodontal field. Taking all measures to prevent inter-human aggression is imperative and will lead to a major decrease in maxillofacial fractures and an overall increase of oral health in a population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01503-5.

Effects of exogenous nerve growth factor on the expression of BMP-9 and VEGF in the healing of rabbit mandible fracture with local nerve injury

BACKGROUND

Mandibular fracture healing is a complex process involving nerves and growth factors. Nerve growth factor (NGF) not only facilitates the maintenance of sympathetic neurite growth but also stimulates other growth factors that can promote the essential osteogenesis and angiogenesis for fracture healing. Therefore, it is necessary to analyze the combined effects of NGF, bone morphogenic protein-9 (BMP-9), and vascular endothelial growth factor (VEGF) to accelerate the healing of mandible fractures.

METHODS

The models of mandible fracture with local nerve injury established in 48 rabbits were randomly divided into nerve growth factor group (NGF group), gelatin sponge group (GS group), blank group, and intact group. The recovery of nerve reflex was assessed by observing the number of rabbits with lower lip responses to acupuncture. The fracture healing was observed with visual and CBCT, and then callus tissues from the mandibular fracture area were collected for hematoxylin and eosin (HE) staining observation, and the expression of BMP-9 and VEGF in callus at different stages was detected by quantitative real-time PCR (qRT-PCR).

RESULTS

Needling reaction in the lower lip showed the number of animals with nerve reflex recovery was significantly higher in the NGF group than that in the GS and blank groups at the 2nd and 4th weeks after the operation. The combined results of macroscopic observation, CBCT examination, and histological analysis showed that a large number of osteoblasts and some vascular endothelial cells were found around the trabecular bone in the NGF group and the amount of callus formation and reconstruction was better than that in the GS group at the 2nd week after the operation. The qRT-PCR results indicated that the expression levels of BMP-9 and VEGF in the four groups reached the highest values at the 2nd week, while the expression levels of both in the NGF group were significantly higher than that in the GS group.

CONCLUSION

The exogenous NGF could accelerate the healing of mandible fractures. This work will provide a new foundation and theoretical basis for clarifying the mechanism of fracture healing, thereby promoting fracture healing and reducing the disability rate of patients.

Trends in mandibular fracture patterns in central Telangana - A retrospective overview and analysis

BACKGROUND/AIM

Socio-economic, environmental and cultural influences may lead to discrepancies in the distribution and occurrence of orofacial injuries. The aim of this study was to analyze the patient demographics and current patterns of mandibular fractures within a geographic population.

MATERIAL AND METHODS

The medical records of patients with facial trauma treated over a period of 3 years were retrieved and reviewed. Their data were analyzed based on the following parameters-age, gender, mechanism of trauma, seasonal variation, drug/alcohol abuse at the time of trauma, number, and anatomic location of fractures.

RESULTS

Of all the patients with maxillofacial injuries, 56% had mandibular fractures and 80% of these were sustained in road traffic accidents. Nearly 44% of patients had multiple mandibular fractures giving an average of about 1.6 fractures per mandible. Alcohol abuse was seen in 39% of patients. Seasonal influence indicated that the monsoon season had the highest incidence of trauma.

CONCLUSION

Fracture patterns vary according to the etiology of the fracture and direction of the impact force. This information can help in the diagnosis and as a guide to future funding of preventive public health programs.

A 6-Year Epidemiological Study of Mandibular Fractures in Traumatic Patients in North of Iran: Review of 463 Patients

BACKGROUND

Mandibular fracture is considered the second most common facial fracture worldwide. We aimed to evaluate the epidemiology of mandibular fractures in traumatic patients hospitalized at Velayat Teaching Hospital in Rasht, Iran for 6-year.

METHODS

In this retrospective study, all traumatic patients with mandibular fractures admitted to Velayat Teaching Hospital, Rasht, northern Iran for 6-year (2013-18) were enrolled. The data collection tool was a checklist consisting of two parts: demographic information, and injury data. All data were collected through the Hospital Information System (HIS), and analyzed using SPSS software and descriptive and analytical statistics tests.

RESULTS

Overall, 463 hospitalized patients were reviewed. Males had higher frequency than females. The most common accident place was rural roads. The most frequent mechanism of fractures was road accidents. The most common injuries occurred in motorcyclists, followed by car passengers, pedestrians, and cyclists. The highest and lowest frequency of injury occurred in September, and February, respectively. The most common site of fracture was condyle, followed by trunk. In concurrent fractures, the most frequently affected site was maxillary bone, followed by zygomatic bones, orbital, nasal, and frontal bones.

CONCLUSION

The majority of patients with mandibular fractures were young men of working age following motor vehicle accidents. Consequently, the most effective strategy for reducing accidents leading to mandibular fractures is considering all three components of human, environment, and vehicle.

Aetiology, prevalence, fracture site and management of maxillofacial trauma

INTRODUCTION

Maxillofacial fractures are often associated with severe morbidity, functional deficit, disfigurement and significant financial implications. The aim of this review was to investigate whether the aetiology, prevalence and management modalities of facial trauma can identify the common causes of facial trauma with a view to recommending measures to the appropriate governing bodies to change the current practice wherever possible.

METHODS

The records of 1,112 patients referred to our oral and maxillofacial unit in Andhra Pradesh, India, between February 2008 and October 2017 were analysed retrospectively. Data including age, sex, aetiology, fracture site and treatment were evaluated.

RESULTS

Men aged 20-40 years were the most common victims of facial trauma. Road traffic accidents (RTAs) were responsible in 70% of cases. Mandibular fractures constituted 47% of the overall fractures, and 55% of the total fractures were treated with open reduction and internal fixation.

CONCLUSIONS

The main cause of maxillofacial injury among patients reporting to our hospital was RTAs. Mandibular fractures were the most common, accounting for almost half of the cases. Over half (55%) of all maxillofacial fractures were treated with open reduction and internal fixation. Reasons for this high frequency may include the large number of poorly maintained, overloaded vehicles on unsuitable roads, violation of traffic regulations (particularly by inexperienced young drivers), abuse of alcohol or other intoxicating agents and the sociocultural behaviours of some drivers.

Evaluation of labial versus labio-inferior lines of osteosynthesis using 3D miniplate for fractures of anterior mandible: A finite element analysis with a pilot clinical trial

PURPOSE

The fractures of anterior mandible are subject to severe torsional forces due to muscles acting in opposite directions. 3D miniplate has been suggested as a good alternative by some researchers. However, finite element model (FEM) studies indicate that labio-inferior positioning of two miniplates perpendicular to each other offers better stability as compared to labial positioning. This study aims at combining the advantages of a single 3D miniplate and labio-inferior positioning of two conventional miniplates, which was assessed by finite element analysis along with a pilot clinical trial.

METHODS

Two FEM models were created using CT data of a 24-year-old patient with Angle class I occlusion: control model with labial plating and study model with labio-inferior plating. The models were processed with MIMICS® (materialise, Leuven, Belgium), CATIA® (Dassault Systemes) and finite element analysis softwares. Parameters adopted for analysis were (1) displacement (mm) of fracture fragments during each screw fixation, (2) lingual splay and post fixation stability of fracture fragments with masticatory load, and (3) stress distribution (MPa) across fracture fragments. Moreover, a pilot clinical trial including five patients with anterior mandible fracture was conducted. The fractures were managed by intraoral open reduction and 3D miniplate fixation in labio-inferior position. Intraoperative interfragmentary gap, post fixation lingual splay and radiographic fracture union and complications were assessed clinically.

RESULTS

Labio-inferior plating demonstrated less displacement (mm) of fracture fragments during screw fixation (0.059 vs. 0.079) as well as after application of masticatory load (1.805 vs. 1.860). Negligible lingual splay and less stress distribution (MPa) across fracture fragments (1.860 vs. 1.847) were appreciated in the study group as compared to control group. Clinical trial support the favorable outcome related to intraoperative and postoperative assessment parameters.

CONCLUSION

FEM analysis and clinical trial reveal better results with labio-inferior positioning of 3D miniplate when compared to labial positioning.

Analysis of Mandibular Fractures: A 7-year Retrospective Study

Background:

Mandibular fractures contribute to a substantial proportion worldwide. Various variables related to mandibular fractures such as demographics, etiology, pattern of fracture, and treatment have been studied, but fewer reports on their correlations are published. Hence, this study attempts to understand these factors which can be useful for setting up clinical and research priorities.

Aim:

The purpose of this retrospective study is to establish a correlation between different factors associated with mandibular fractures.

Materials and Methods:

A database of 277 patients between July 2011 and October 2018 with mandibular fractures was retrospectively retrieved. Information on age, gender, etiology, pattern of fracture, and treatment done was obtained, tabulated, and analyzed statistically. Entities such as age and gender, age and cause, gender and cause, site of fracture and cause, site of fracture and side, site of fracture and treatment done, and site of fracture and gender were correlated.

Statistical Analysis Used:

Descriptive and analytical statistics were calculated using the SPSS version 20 using Chi-square tests which include Pearson's Chi-square and likelihood ratio.

Results:

In a total of 277 patients, a statistically significant correlation was found between age and the etiologic agent, site and side of fracture, and site of fracture and the treatment done with value of P < 0.05.

Conclusion:

A definite correlation between multitude of overlooked relevant co-factors has been studied which can provide an operating surgeon, a valuable impetus to be more vigilant in terms of medicolegal record maintenance, diagnosis, and possible clinical strategy for the treatment of mandibular fractures.

Prevalence of mandibular fracture in patients visiting a tertiary dental care hospital in North India

Background:

Injuries of the maxillofacial complex represent one of the most important health problems worldwide. At present, in developing India, due to poor traffic sense, maxillofacial trauma and fractures are most epidemiologic diseases. Mandible is the largest and strongest facial bone and it is the second most commonly fractured bone. Mandibular fractures can involve only one site or can often involve multiple anatomic sites simultaneously.

Aims:

The present study is aimed to know the age- and sex-related prevalence of parasymphyseal fracture, fracture of angle, condylar fracture, symphyseal fracture, and coronoid fracture of mandible in North Indian population. It also evaluates the correlation of prevalence of parasymphyseal fracture, angle of mandible, condylar fracture of mandible, symphyseal fracture of mandible, and coronoid fracture of mandible.

Materials and Methods:

All patients fulfilling the selection criteria and having mandible fracture were selected for the study. The data about mandibular fracture was collected by means of a structured questionnaire including age, sex, and anatomic site of fracture. Qualitative variables were compared using Chi-square test/Fisher's exact test as appropriate.

Results:

The study population consists of 1015 individuals aged between 7 and 68 years with the mean age of 33.49 ± 11.79 years. The most common anatomic site for mandibular fracture was parasymphyseal region (40.3%) followed by angle (28.8%), condyle (27.6%), and symphysis (12.5%) of mandible. The coronoid process of mandible (44, 4.3%) was least involved in mandibular fracture. Males (30.8%) are more predilected for condylar fracture than females (15.7%). The mandibular symphyseal fracture is more common in male (14.9%) than female (3.7%).

Conclusion:

Mandibular fractures occur in people of all ages and races, in a wide range of social settings. Their causes often reflect shifts in trauma patterns over time. The present assessments of mandibular fracture will be valuable to government agencies and health-care professionals involved in planning future programs of prevention and treatment.

Erich arch bar versus hanger plate technique for intermaxillary fixation in fracture mandible: A prospective comparative study

Introduction:

Various methods have been described for intermaxillary fixation (IMF) for treatment of faciomaxillary injuries. Many studies have been described to evaluate the efficacy of different methods. Hanger plate method has not been commonly used. The aim of the present study was to compare the advantages and disadvantages of this method over Erich arch bar in mandibular fracture.

Materials and Methods:

Sixty patients of only mandibular fracture presenting to trauma center requiring open reduction and internal fixation under general anesthesia were randomly allocated to Group A and Group B comprising thirty patients in each. Group A included patients who received IMF with Erich arch bar. Group B included patients who received IMF with hanger plate method. The two groups were compared for time duration of intermaxillary procedure, total duration of surgery, oral hygiene score, postoperative occlusion, and complications.

Results:

The average time of intermaxillary procedure, total duration of surgery, and wire prick injuries were more in Group A. Oral hygiene score was significantly better in Group B. Postoperative occlusion was comparable between the two groups. There was screw loosening in four patients in Group B, but none had tooth root injury. The cost of material for IMF was more in Group B.

Conclusion:

IMF with hanger plate method is more safe and efficacious compared to Erich arch bar in the treatment of mandibular fractures.

Incidence and Pattern of Mandible Fractures in the Madinah Region: A Retrospective Study

Objectives

The objective of the study is to study the incidence and pattern of mandible fractures in the holy city of Madinah in the Kingdom of Saudi Arabia over a retrospective period of 3 years from 2013 (1434H) to 2016 (1436H) and to compare the results with those from other regions of Saudi Arabia and elsewhere.

Materials and Methods

Relevant data of patients admitted to the King Fahad Hospital, Madinah with a fracture of the mandible during the study were collected from their medical records and radiographs. The age, gender, etiology, role of the patient, site, and number of fractures in the patients were evaluated. The data were analyzed by standard statistical methods.

Results

A total of 197 patients with fracture of the mandible were admitted in the period of the study by the Oral Maxillofacial Surgery Department, King Fahad Hospital, Madinah. There were 165 male and 32 female patients. The ages ranged from 3 to 86 years with a mean of 24 years. A total of 260 fractures of Mandible were documented. The largest number (113) of patients was found in the age group between 16 and 30 years. Trauma caused by motor vehicle road traffic accidents (RTAs) was the main etiology of the fractures followed by falls and assault. The majority of the patients were in the role of vehicle drivers. The condylar anatomical site of mandible was most frequently affected and constituted the largest number (103) of fractures followed by the angle (51), parasymphysis (45), and then by the body (23) of the mandible. Dentoalveolar fractures were present in 22 cases. Very less number of coronoid fractures (7), followed by those of the ramus (5), and least number at the symphysis (4) of the mandible were found.

Conclusion

RTA was the most common etiology for trauma and fracture of the mandible. The males outnumbered the female patients, the largest number of patients with trauma and mandible fracture was found in the age group between 16 and 30 years and frequency of condylar fractures was higher.

Cervical injury related to mandibular fractures. A retrospective study of 315 cases

Objective To define the association between mandibular fractures and alterations of the cranio-atlo-axial joint (CAAJ). Methods 315 cases of displaced mandibular fractures were retrospectively evaluated by CT scan and cervical X-ray for associated alterations of the CAAJ. Statistical analysis employed the chi-square and Cohen's kappa coefficient. Results Single fractures amounted to 69.84% and multiple fractures to 30.16% of total fractures. CT scans showed a rotation of the atlas on the same side of single fractures and subluxation of the CAAJ. Vertical derangement of the joint was observed in 79.65% of single fractures and in 20.35% of multiple fractures. Approximately16.19% of all displaced mandibular fractures showed cervical disorders at long-term follow-up. Discussion The outcomes of this study revealed an association between traumatic mandibular fractures and CAAJ, accompanied by clinical disorders. These conditions require clinical attention due to their effects on long-term craniocervical functionality and future forensic issues.

Imaging in traumatic mandibular fractures

A fracture of the mandible is a common trauma presentation amongst young males and represents one of the most frequently encountered fractured bones within the viscerocranium. Historically, assault was the dominant contributing factor but now due to the increased number of vehicles used per capita, motor vehicle accidents are the primary cause. Mandibular fractures can be classified anatomically, by dentition, by muscle group and by severity. The fracture may also be closed, open, comminuted, displaced or pathological. It is important that the imaging modality used identifies the classification as this will decide definitive treatment. X-ray projections have typically been used to detect a mandibular fracture, but are limited to an anteroposterior (AP), lateral and oblique view in an unstable trauma patient. These views are inadequate to detail the level of fracture displacement and show poor detail of the condylar region. Computer tomography (CT) is the imaging modality of choice when assessing a traumatic mandibular injury and can demonstrate a 100% sensitivity in detecting a fracture. This is through use of a multidetector-row CT, which reduces motion blur and therefore produces accurate coronal and sagittal reconstructions. Furthermore, reconstructive three-dimensional CT images gained from planar views, allows a better understanding of the spatial relationship of the fracture with other anatomical landmarks. This ensures a better appreciation of the severity and classification of a mandibular fracture, which therefore influences operative planning. Ultrasound is another useful modality in detecting a mandibular fracture when the patient is too unstable to be transferred to a CT scanner. The sensitivity however is less in comparison to a CT series of images and provides limited detail on the fracture pattern. Magnetic resonance imaging demonstrates use in assessing soft tissue injury of the temporomandibular joint but this is unlikely to be of priority when initially assessing a trauma patient.

A Comparative Evaluation of Closed and Open Treatment in the Management of Unilateral Displaced Mandibular Subcondylar Fractures: A Prospective Randomized Study

The aim of the study is to evaluate closed and open treatment in the management of unilateral displaced mandibular subcondylar fractures. Twenty patients with unilateral subcondylar fractures of the mandible were evaluated with degree of displacement of more than 20 degrees and ramal height shortening of more than 10 mm. They were informed of the need for 6-month follow-up. Patients were thoroughly informed, explaining the possible advantages and disadvantages of the open and closed treatment options. Radiographic parameters included the level of fracture, deviation of fragment, and ramal height shortening. Correct anatomical reduction is achieved by open treatment as compared with closed treatment. Regarding pain, mouth opening, and lateral excursion movement, statistically significant difference was found in both groups ( p  < 0.01). In radiographic assessment of ramal height shortening and fracture displacement, statistically significant difference was found ( p  < 0.01). And no significant complication is found in both treatment groups. The results of this study favor the open treatment for the management of displaced subcondylar fractures. However, the treatment results are also acceptable for closed group.

Mandibular Ramus Fracture: An Overview of Rare Anatomical Subsite

Aim. The present study aims at exemplifying the incidence, and aetiology and analyses the outcomes of open reduction internal fixation (ORIF) over closed treatment of mandibular ramus fractures. Patients and Method. In the present retrospective analysis of mandibular fracture patients, variables analysed were age, sex, cause of injury, pretreatment occlusion, treatment given, period of maxillo-mandibular fixation (MMF), and posttreatment occlusion. Results. Out of 388 mandibular fractures treated, ramus fractures were 12 (3.09%). In the present study, predominant cause of mandibular ramus fracture was road traffic accident (RTA) n = 07 (58.33%) followed by fall n = 04 (33.33%) and assault n = 1 (8.33%). The average age was 35.9 years with a male predilection. Of these, 9 patients were treated with ORIF while remaining 3 with closed treatment. The average MMF after closed treatment was 21 days and 3 to 5 days after ORIF. There was improvement in occlusion in all 12 patients posttreatment with no major complication except for reduced mouth opening in cases treated with ORIF which recovered with physiotherapy and muscle relaxants. Conclusion. Mandibular ramus fractures accounted for 3.09% with RTA as a common aetiology. ORIF of ramus fractures facilitated adequate functional and anatomic reduction with early return of function.

A study of mandibular fractures over a 5-year period of time: A retrospective study

Objective:

This study aims to evaluate and compare with the existing literature on the etiology, pattern, gender, and anatomical distribution of mandibular fractures.

Materials and Methods:

The data of 225 cases were analyzed over a period of 5 years between March 2009 and November 2013. Of this 110 were unilateral, 23 bilateral, 18 symphysis and 74 multiple fractures.

Results:

Males are more affected than females. The peak incidence rate is occurring in 30-35 years of age group. The most common fracture site is parasymphysis and least common site is ramus of mandible. The most common etiological factor is road traffic accident (RTA) (45.3%) followed by falls (42.6%), assaults (8.9%), sport injuries (2.2%), and gunshot wounds (0.89%).

Conclusion:

Thus, we conclude that RTA is the leading cause of mandibular fractures and males are more affected. The most common site is parasymphysis fracture in association with angle fracture. We observed that gender was significantly associated with body and angle fracture (P = 0.04) and significant relationship between etiology with multiple site fracture such as (parasymphysis-angle), (body-condyle), (body-angle), and (symphysis-condyle) was observed (P ≤ 0.05).

Retrospective clinical study of mandible fractures

Objectives

The purpose of this article is to analyze the incidence, demographic distribution, type, and etiology of mandible fractures that were treated by the Department of Oral and Maxillofacial Surgery in Kyung Hee University Dental Hospital from January 2002 to December 2012.

Materials and Methods

This was a descriptive and analytic retrospective study that evaluated 735 patients that were treated for mandible fracture.

Results

This study included 1,172 fractures in 735 patients. The ratio of male to female patients was 5.45 : 1; the maximum value was in patients between 20 and 29 years (38.1%) and the minimum in patients over 70 years old. The monthly distribution of facial fractures peaked in the fall and was lower during winter. No specific correlation was identified based on the annual fracture distribution. Among the 735 fracture patients, 1.59 fracture lines were observed per patient. The most frequent site was the symphysis, which accounted for a total of 431 fractures, followed by the angle (348), condyle (279), and body (95). The symphysis with angle was the most common site identified in combination with fracture and accounted for 22.4%, followed by symphysis with condyle (19.8%). The angle was the most frequent site of single fractures (20.8%). The major cause of injury was accidental trauma (43.4%), which was followed by other causes such as violence (33.9%), sports-related accidents (10.5%), and traffic accidents (10.1%). Fracture incidents correlated with alcohol consumption were reported between 10.0%-26.9% annually.

Conclusion

Although mandible fracture pattern is similar to the previous researches, there is some changes in the etiologic factors.

Total avulsion of mandible in maxillofacial trauma

Mandibular trauma are a frequent injury of maxillofacial skeleton due to the mandible's prominence and relative lack of support. Maxillofacial injuries can be complex and can involve the skin and soft-tissues as well as bones resulting in fractures. Although, several cases of severe crush injury of the lower jaw have already been presented but total avulsion of mandible has rarely been reported. As with any facial fracture, consideration must be given for the need of emergency treatment to secure the airway or to obtain hemostasis if necessary before initiating definitive treatment. We presents a case report of completely avulsed mandible along with soft-tissue of midface region in pediatric patient following trauma, which was attempted to manage or repaired by successful microvascular surgical technique. Unfortunately, we lost the patient in next postoperative day due to cardiac complication. Avulsion of the lower jaw may further complicate the obstructive nature of the upper airway. Multi-specialty involvement in their management may be needed for management of such type of avulsion injury.