Association Between Trauma Mechanism and Mandibular Fracture Pattern: A 13-Year Retrospective Analysis at a Regional Trauma Center.

Study Design: Cross-sectional study. Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City. Methods: A three-year cross-sectional study was done at Balbuena General Hospital in Mexico City. The variables of interest were age, gender, place of origin, fracture site, trauma mechanism, and treatment. Between 2016 and 2019, physical and electronic data records of patients that exhibited facial fractures were included. Statistical analyses performed included descriptive analysis and a chi-square test. Results: A total of 490 cases of fractures in the maxillofacial region were reviewed, of which 237 (47%) cases presented fractures in the midface. A higher male ratio (M: F 12:1) was observed. The age range varied between 18 and 80 years, with a mean of 35.58 ± 14 years. The most frequent diagnosis was a zygomatic complex fracture, 37.97%. (n = 90). The most frequent trauma mechanism was interpersonal violence at 55.93% (n = 132) in both places of origin (P = .06). Conservative treatment was more frequent at 71.67% in intrapersonal violence (P = .019). Interpersonal violence was more frequent in males at 61.64%, and motor vehicle accident was more frequent in female at 61.11% (P = .028). Conclusions: The analysis provides information that can help to focus preventive measures regarding facial fractures, especially on efforts to reduce interpersonal violence.

Mandibular fractures are the most common fractures of facial bones. If the fracture is detected and the occlusion is affected, surgery is the best option. Motor vehicle accidents and fall injuries are the most common reasons for combined injuries of maxillofacial and cervical spine (c-spine). The most common scenario is the cooccurrence of midfacial trauma and upper c-spine injuries. Despite the low incidence of the cooccurrence of spinal injuries and maxillofacial trauma, it is crucial to have guidelines that assess and manage this situation because of its severe outcomes.

Traumatic brain injury (TBI) associated with facial fractures is a major public health concern worldwide. The rate of TBI in patients with mandibular fractures ranges from 21.3% to 39.6%. However, the risk factors for TBI in patients with mandibular fractures remain unknown. Our study evaluates these risk factors. We retrospectively reviewed patients who presented with traumatic mandibular fractures in 2018 and 2019. Excluded were patients with no documentation of Glasgow Coma Scale. Our primary outcomes were: (1) prevalence of concomitant TBI on presentation defined as having a positive head computed tomography scan (hemorrhage, parenchymal contusion, diffuse axonal injury), or a negative scan with Glasgow Coma Scale < 15 or any neurologic symptom/sign; (2) prevalence of posttraumatic neurologic symptoms assessed at ≥4 weeks after injury. The mandibular injury severity score (MISS) was calculated for all patients. Bivariate analysis and multivariable logistic regression were performed. Of 390 patients with mandibular fractures, 165 (42.3%) had concomitant TBI on presentation. Of those, 61% (n = 101) had mild TBI, 12% (n = 20) had moderate TBI, and 27% (n = 44) had severe TBI. Almost half of the mandibular fractures were due to assault (182 [47%]). Older age at injury and the presence of other facial fractures were associated with significantly greater odds of TBI on presentation (adjusted odds ratio 95% confidence interval [CI] 1.016 [1.001-1.032], P = 0.040; 2.457 [1.551-3.891], P < 0.001). Of 195 patients who were assessed at ≥4 weeks after injury, 99 (51%) had neurologic symptoms, most commonly facial numbness (74 [38%]). Mandibular body fracture and a high MISS were associated with significantly greater odds of having neurologic sequelae at ≥4 weeks after injury (adjusted odds ratio [95% CI] 3.12 [1.31-7.50], 1.12 [1.04-1.20]). Older patients and those with mandibular body fractures and a high MISS may benefit from TBI screening and close longitudinal follow-up to identify and manage neurologic sequelae.

Inferior Alveolar Nerve Injury in Trauma-Induced Mandible Fractures

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.

Occurrence and Severity of Concomitant Injuries in Other Areas Than the Face in Children With Mandibular and Midfacial Fractures

Prosthodontics- 2017- Infected Mandibular Fractures: Risk Factors and Management- Ehab Abdelfadil- Mansoura University

The purposes of this study were to investigate the occurrence and patterns of dental trauma in patients with single mandibular fracture and to evaluate the relationships between dental injury and fracture site of mandible. From January 2000 to December 2009, 869 patients with mandibular fractures were registered. Only the patients with single mandibular fracture were included. The information and data collected included age, gender, mechanism of injury, type of mandibular fracture, and type of dental injury. Single mandibular fractures were sustained in 294 (33.8%) patients. Of these, 43.5% (128 patients) presented with associated dental injuries (509 injured teeth). The patients' male/female ratio was 2.46:1 (91 males and 37 females). Patients in 30-39 year age group possessed the highest risk of suffering dental trauma (odds ratio = 2.004, P = 0.014). Road traffic accidents were the most common mechanism of injury (54, 42.2%). Lower-anterior teeth were more often injured in patients with symphysis fracture (P < 0.001), and patients with condylar fracture more frequently sustained upper-posterior teeth injury (P < 0.001). Lower-posterior teeth injury was mostly found in patients with mandibular body fracture (P < 0.001) or angle fracture (P < 0.001). Dental injuries were more prone to occur in patients who sustained only symphysis fractures (odds ratio = 3.283, P < 0.001), and the risk was only 0.193-fold in patients who sustained only mandible angle fractures (odds ratio = 0.193, P < 0.001). The occurrence and type of dental injury were significantly related to the fracture site of mandible.

To analyze the epidemiological characters of fresh maxillofacial fractures in hospitalized patients by the retrospective study. From Jan. 2008 to Dec. 2013, a total of 1 009 patients with fresh maxillofacial fractures treated at Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were investigated. The data were statistically analyzed by SPSS 21.0. The male and female ratio was 2.94:1 and 33.5% of the patients aged from 20 to 30 years. The most common cause of the fresh fracture was road traffic accidents (424 cases, 42.0%), followed by tumblings (250 cases, 24.8%) and violence (128 cases, 12.7%). The number of new fracture was increasing gradually in recent years. The patients were at peak of 20-29 years old. The mandibular fracture was the most frequently seen (536 cases, 53.1%), followed by zygomatic complex fractures (233 cases, 23.1%). The simple maxillary fracture was rare and usually combined with other fractures. Infraorbital nerve injury was the most common one in nerve injuries (144 cases). The most common associated injury was extremity injuries (77 cases), followed by thoracic injury (65 cases) and craniocerebral injury (57 cases). Associated injuries were mostly caused by car accidents (127 sites), followed by fall (32 sites). Logictic regression analysis showed that fall and tumbling were risk factors of mandibular and condylar fracture (OR > 1, P < 0.05), while age was a protective factor (OR > 1, P < 0.05). Oral and maxillofacial fresh fractures most commonly occurred in young people, and the most common cause of fractures was road traffic accidents. Infraorbital nerve was involved frequently. The most common associated injuries was extremity injuries.

Background: To plan optimal treatment, obtain satisfactory outcomes, and avoid undesirable clinical errors, surgeons need to have efficient tools for providing a complete and prompt diagnosis. The aim of this study was to establish the sensitivity, specificity, positive and negative predictive values, false positive rate, and false negative rate of the "air sign" (AS) within soft tissues as an indirect radiological indicator of mandibular body and angle fractures. Methods: A retrospective analysis of preoperative computed tomography (CT) and cone beam computed tomography (CBCT) scans was performed on patients with mandibular fractures within a three-year period. Two fracture types were analyzed: open and closed fractures. Results: Forty-three patients with a total of 71 mandibular fractures were included in the study. The mean age of the patients was 35 years, and the majority were male (83.7%). The sensitivity of the AS was 92.2%, specificity = 90.0%, positive predictive value = 95.9%, negative predictive value = 81.8%, false positive rate = 10.0%, and false negative rate = 7.8%. Higher values were observed for open fractures compared to closed fractures. Conclusions: The sensitivity and specificity of AS are lower than those of OPG, CT, and CBCT. However, AS offers an important additional radiological indicator that can effectively reduce the risk of misdiagnosing mandibular body and angle fractures.

Link of Video Abstract: https://youtu.be/dT_k0C9UhI0 Background: Maxillofacial fracture is one of the most common injuries in trauma patients, especially in patients with traffic accident mechanisms. In this study, we aim to analyze the profile of patients with maxillofacial fractures, especially mandibular fractures, who came to tertiary hospitals. Methods: Observational descriptive study to evaluate the profile of mandibular fracture patients who came to the Emergency Department of the Head and Neck Surgery Division of Dr. Soetomo General Hospital Surabaya in 2022. Data were analyzed using SPSS version 23.0 for Windows. Results: Subjects were grouped according to age, sex, and mechanism of trauma. The most prevalent gender was male. The age group with the highest prevalence of accidents was 11-20 years (32.5%). Most maxillofacial traumas were caused by traffic accidents (92.5%). Associated trauma was found in 65% of subjects. Mandibular fractures tend to occur as part of multiple maxillofacial fractures compared to a single maxillofacial fracture, which is as much as 65%. The most common location of the fracture line in the mandible is the mandibular parasymphysis, which accounted for 33.3% of all samples. The most common mandibular fracture lines were 2 lines (47.5%). Conclusion: Mandibular fractures are more likely to be part of multiple maxillofacial fractures than a single maxillofacial fracture and are often accompanied by concomitant trauma to other organs than a single trauma.

Although not previously reported, experience suggests that dentoalveolar injury is -common among patients with maxillofacial fractures. The objective of this study was to evaluate and describe the prevalence and nature of dentoalveolar injuries in patients identified with maxillofacial fractures. Medical records of 43 dogs and cats diagnosed with maxillofacial fractures between 2005 and 2012 were reviewed to identify patients with concurrent dentoalveolar injury. Medical records of patients with dentoalveolar injury were abstracted for the following information: signalment (including sex, age and skull type), mechanism of maxillofacial trauma, location and number of maxillofacial fractures, dentoalveolar injury type and location and the number of dentoalveolar injury per patient. Statistical evaluation was performed to determine associations between signalment, mechanism of trauma, location and number of maxillofacial fractures and the prevalence and nature of concurrent dentoalveolar injury. Dentoalveolar injuries are common among patients with maxillofacial trauma. Age and mechanism of trauma are significant predictors of the presence of dentoalveolar injuries in patients with maxillofacial trauma. The findings of this study serve to encourage veterinarians to fully assess the oral cavity in patients with maxillofacial fractures as dentoalveolar injuries are common and can be predicted by age and mechanism of trauma.

This study aimed to evaluate and analyse the demographic characteristics and changes in maxillofacial injuries during their development in pediatric patients. A retrospective cohort and case-control study was conducted. The sample was composed of all children (less than 10.5 years) who presented with maxillofacial injuries within a 6.5-year period (from December 2012 to April 2019). Data about age, gender, hospitalization date, mechanism of trauma, location and pattern of injuries, associated general injuries or systemic diseases, admission methods (emergency admission or not), type of anesthesia, treatment methods and hospital costs (¥) were recorded and analyzed. Data analysis included Chi-square test, Fisher exact test, and t test. Univariate and multivariate analyses were also performed. Logistic regression analysis was used to control for confounding variables. Differences at P < 0.05 were considered significant. A total of 643 pediatric patients were included in this study, with a boy-to-girl ratio of 1.77:1 (411 boys and 232 girls). The age range was 0.18 to 10.5 years (average of 3.23 ± 1.98 years). The largest age group was patients aged 1 to 2 years (200 patients, 31.1%), followed by 2 to 3 years (139 patients, 21.6%). In the majority of patients, fall at ground level was the most common mechanism of injury (391 patients, 60.8%). In addition, 613 patients (95.3%) sustained at least maxillofacial soft-tissue injuries, while 460 (71.5%) sustained only maxillofacial soft-tissue injuries and 183 (28.5%) sustained maxillofacial fractures. Lip was the most vulnerable soft tissue to be injured (283 patients, 44.0%). Patients who sustained maxillofacial soft-tissue injuries were less prone to maxillofacial fractures than those who did not. Maxillofacial fractures were highly presented in patients with dental injuries (OR = 6.783; 95% confidence interval, 3.147-14.620; P < 0.001). Older children (> 5 years old) were at higher risk of maxillofacial fractures than younger children (≤ 5 years old, P = 0.006). The risk of maxillofacial fractures (except symphysis fractures) increased with age, especially in patients aged between 5 and 10 years. Maxillofacial soft-tissue injuries were highly distributed amongst patients aged 1 to 5 years. The number of patients who sustained only maxillofacial soft-tissue injuries gradually decreased from 2013 to 2018. Patients in emergency admission (OR = 13.375; 95% confidence interval, 1.286-139.121; P = 0.030) and treated under general anesthesia (OR = 27015.375; 95% confidence interval, 1033.046-706484.218; P < 0.001) were more prone to be treated by surgery procedure. Patients with facial fractures were less frequent to be treated by surgery procedure (OR = 0.006; 95% confidence interval, 0.000-0.575; P = 0.028); however, the mandibular symphysis (OR = 18.141; 95% confidence interval, 2.860-115.069; P = 0.002) or body fractures (OR = 71.583; 95% confidence interval, 2.358-2172.879; P = 0.014) were highly treated by surgery procedure. Maxillofacial fractures in pediatric patients were significantly related to age, etiology, maxillofacial soft-tissue injury, dental injury and other general injuries. Older pediatric patients were at higher risk of maxillofacial fractures (except symphysis fractures) and lower risk of maxillofacial soft-tissue injuries than younger pediatric patients. Patients in emergency admission, fractures of the symphysis or body, and treated under general anesthesia were the main reasons for surgical management.

This study aimed to identify and distinguish various factors that may influence the occurrence of mandibular coronoid fractures. From January 2000 to December 2009, a total of 1131 patients with maxillofacial fractures were enrolled in this statistical study to evaluate the association between mandibular coronoid fractures and other risk factors. Among these patients, 869 had mandibular fractures, and 25 sustained a total of 25 coronoid fractures. More than half (13 of 25 patients, 52%) of the coronoid fractures in these patients were caused by motor vehicle accidents. Among these coronoid fractures, seven were associated with other mandibular fractures, and 23 (92.0%) were related to midfacial fractures. The most common site of midfacial fracture was the zygomatic arch (20 patients, 80%). Multivariate logistic regression analysis revealed that the most important influencing factor was the zygomatic arch fracture (odds ratio, 9.033; 95% confidence interval, 1.658, 49.218; p = 0.011). The majority of coronoid fracture fragments (19 of 25, 76%) were removed during operation. The most commonly used incision is hemicoronal or bicoronal approach (16 of 19, 84.2%).

Paediatric facial fractures are relatively rare due to the elasticity of children´s bones. This elasticity can also make such fractures more challenging to diagnose. Additionally, anatomical differences between juveniles and adults influence the types of fracture observed. In general, boys are more susceptible to trauma; however, this trend does not seem to differ in cases of facial fractures. The aim of this study is to investigate the association between sex and trauma mechanisms in paediatric facial fractures. A retrospective cohort study was conducted on paediatric patients diagnosed with facial bone fractures between 2008 and 2018 at Päijät-Häme Central Hospital (Lahti, Finland). Inclusion criteria were one or more fractures in facial bones in patients under 18years of age. Of the 37 study subjects, 19% were female and 81% were male. Among females, the most common trauma mechanisms were bicycle accidents and sports related incidents (both 8.1%), whereas in males, motor vehicle accidents and sports related incidents were equally prevalent (both 24%). Associated injuries were uncommon, occurring only in 16% of cases, and they were particularly linked to motor vehicle accidents. Paediatric facial fractures are rare. Mandibular fractures are more frequent in both the 6-12 and 13-18-year age groups. No consistent association between dentition stage and fracture site is observed. In both sexes, sports related incidents are the most common trauma mechanism, followed by bicycle accidents in girls and MVAs in boys. Differences between trauma mechanisms and facial fracture locations are minor. Associated injuries are infrequent and typically occur in connection with high-energy trauma, such as MVAs.