Review of 10 Years Through 2014 and 2024, for Mandibular Fractures: A Retrospective Study

Trends in the incidence and cause of sport-related mandibular fractures: A retrospective analysis

Relevance of the study: this is the first Lithuanian study, which analyzes in detail the incidence, etiology and circumstances of mandibular fractures treated in the Vilnius University Hospital, Lithuania. The data and findings of this study are compared with other studies, identifying specific mandibular trauma patterns in Lithuania. Background. During past few decades, the socioeconomic situation in Lithuania has been changing significantly, and there is a need to evaluate data about mandibular fracture epidemiology and etiology. The aim of the study was to analyse the incidence, etiology, circumstances and localization of mandibular fractures treated in the Department of Oral and Maxillofacial Surgery, Vilnius University Hospital Žalgiris Clinic, Lithuania. Materials and methods. The medical records of 1 508 patients with mandibular fractures, treated between 1 January 2005 and 31 December 2009, were reviewed. The following data were analysed: age, gender, trauma date and time, etiology and circumstances of trauma, fracture area. Results. The male : female ratio was 7.3 : 1. The majority of patients (53.6%) were young people, aged 16–30 years. Mandibular fractures most often (53%) occurred between May and September, mostly at weekends (61%) and in the late evening (60%). The main cause of mandibular fractures was interpersonal violence (70%), followed by falls and accidents (19%), and road traffic accidents (6%). Even 15% of men and 10% of women were alcohol intoxicated at the time of trauma. The most common fracture area was mandibular angle (32%) and condylar process fractures (31%). Conclusions. The incidence of mandibular fractures was remarkably larger in the male, during the second and third decade of life. Most mandibular fractures occurred in the warm period of the year, especially at weekends and late evening. The mandibular basis region was the most common fracture site. The most common cause of mandibular fractures was assault.

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.

Inferior Alveolar Nerve Injury in Trauma-Induced Mandible Fractures

Background:Mandibular fractures constitute a substantial proportion of cases of maxillofacial trauma. Demographic data related to mandibular fractures are difficult to evaluate because of many variables associated with the studies. The information is as diverse as the countries and the people who inhabit them.Aim:This is a retrospective study designed to determine the site distribution, associated fracture and causes of mandibular fractures in patients presenting to the trauma centre of Veer Chandra Singh Garhwali Government Medical Science and Research Institute, Uttarakhand, India.Materials and Methods:Records of 121 patients with confirmed mandibular fractures presenting over a three year period (i.e., 1st January 2008 to 31st December 2010). Data obtained from record included age, sex, site of fracture and causes.Results:There were 48/121 (39.6%) males and 73/121 (60.3%) females. The most predominant age group of fracture was found to be 21-30 (53/121-43.8%) followed by 11-20 (25/121-20.6%). In this study history of fall was the most common cause of mandibular fracture (66/121-54.5%), followed by road traffic accidents (45/121-37.1%), fights and assault (08/121-6.6%) and industrial accidents (02/121-1.6%). In our study most of the patients suffered from fracture in the parasymphysis (35/139-25.1%) and angle region (32/139-23.0%) followed by body (30/139-21.5%), condyle (21/139-15.1%), symphysis (19/139-13.7%), and ramus (02/121-1.4%) area.Conclusion:In this study mandibular fractures were more prevalent in females especially during the second and third decade of life. History of fall was the most predominant cause of mandibular fracture. The most frequently affected sites were parasymphysis and angle.

Angle fractures represent the largest percentage of mandibular fractures. They pose as a unique entity because of their codependent morphological dynamic factors, rendering the understanding of the mechanism, and treatment challenging. The aim of this study was to analyze the association between the mandibular gonial angle and the risk of mandibular angle fracture while highlighting its clinical relevance. A retrospective analysis of radiographs of patients treated for mandibular fractures was done. The factors studied were as follows: the presence of a high gonial angle and an impacted third molar. The outcome was mandibular angle fracture. The gonial angle was measured using Planmeca Digital Software 3.7.0.R. Status of the third molar was also noted. Data obtained were analyzed using SPSS 22 (IBM Corp, Armonk, NY). The sample comprised 70 mandibular fractures (32 angle fractures and 38 non-angle fractures). The mean gonial angle in the angle fracture group was 128.5±5.4º which was 10.2° larger than in the non-angle group (mean 118.5±4.4º; P=0.0001). Patients with a high gonial angle were 8.7 times more likely to sustain an angle fracture than those with normal or low gonial angles. A statistically significant relationship between the presence of impacted third molar and patients sustaining mandibular angle fractures was noted (P=0.0001). Subjects with a high gonial angle and an impacted third molar are at an increased risk for mandibular angle fracture due to direct and indirect morphological factors.

Mandibular fractures constitute a major portion of maxillofacial trauma and may lead to considerable functional and aesthetic sequelae if treatment is inadequate or delayed. An epidemiology study on mandibular fractures may guide the preventive efforts of the Taiwan public health care system. Therefore, a retrospective review was conducted at a medical center in central Taiwan to evaluate the current mandibular fracture epidemiology.The medical records and digitized radiographs of 198 patients who received treatment for mandibular fractures during a 3-year period (from October 2010 to September 2013) at a medical center in central Taiwan were reviewed to obtain demographic and injury data.The average age was 29.4 years (3–82 years). Patients aged 21 to 30 years sustained the most mandibular fractures (62 patients, 31.3%). The overall sex distribution (male to female) ratio was 1.8. Motor-vehicle accidents (MVAs) were the most common mechanism of injury (162 patients, 82%), and scooter and motorcycle riders wearing partial-coverage helmets constituted the majority of patients. A chart review identified 198 patients with 335 mandibular fractures; 113 patients (57.1%) had multiple mandibular fractures. The most common fracture sites were the symphysis and parasymphysis regions (38.9%), followed by the condyle (26.0%), angle (14.3%), body (14.3%), and ramus (6.6%).MVAs are the major cause of mandibular fractures in central Taiwan, and patients aged <30 years sustained the most mandibular fractures. Compared with previous studies, the present study has a higher percentage of women with mandibular fractures. In addition, inadequate mandibular protection by partial-coverage helmets may be a major reason for mandibular fractures most commonly localized in the symphysis and parasymphysis regions. The incidence and causes of mandibular fractures may reflect the trauma patterns within the community, thus facilitating the development of a preventive strategy for the socioeconomic and environmental background of central Taiwan.

The Influence of Mandibular Gonial Angle on Fracture Site

The mandible provides structural support for the teeth and a route for neural and vascular supply to the dentition, as well as sensory perception for the lower one-third of the face. Although the mandible is the largest and strongest facial bone, fractures frequently result as a sequela of facial trauma because of the mandible’s physical prominence in the lower face. Vehicular accidents and assaults are the leading causes of mandibular fractures. 1‐3 Open reduction and internal fixation are often the treatment of choice for significantly displaced mandible fractures. 4 Yet reduction of these displaced bony fragments, and their subsequent stabilization during plating, can be difficult and occasionally cumbersome, involving several instruments and multiple hands in a small operative field. Thus, reduction and plating techniques for open repair of mandible fractures often require two surgeons or at least one surgeon and a skilled technician. To lessen the technical assistance needed and to assist with reduction prior to plating, several methods have been proposed in the literature. These involve the use of towel clamps, screws, and wires. 5 However, in theory, these are not completely optimal. With towel clamp and modified towel clamp techniques, the surgeon is still required to manipulate large clamps while drilling and plating. 5 One must also remember that a large clamp remains in the operative field, possibly compromising direct visualization, especially when operating through a small incision. The screw-wire osteosynthesis technique described by Dym and coworkers was used on more than 40 unfavourable mandible angle fractures as the sole source of repair. 6 This technique uses 8-mm screws and 24-gauge wire at the angle of the mandible. Dym and colleagues reported no complications for their small cohort. 6

To report the causes and classification of mandibular fractures in dromedary camels and outcome after treatment. Single-humped camels (n = 116) with mandibular fracture. At admission, cause, site, classification, and radiography of mandibular fractures were recorded. Factors affecting fracture healing were analyzed. Biting was the main cause of mandibular fractures in camels, which occurred more commonly in older males (P = .001) than in females. Open fractures were more common than closed ones (92.2% versus 7.8%, P = .0001) and single fractures were more frequent (82%) than multiple and comminuted fractures (18%; P = .001). Fractures were treated by interdental wiring (91.2%) or U-shaped aluminum bar (8.8%) and healing occurred in most (83.2%) fractures. In dromedary camels, mandibular fracture is most commonly caused by bites and can be successfully repaired by interdental wiring or a U-bar technique with good outcome.

Removal of lower third molar corresponds to one of the most common procedures in oral surgery. The extraction can result in several intraoperative or postoperative complications, especially when fully impacted molars are involved. This case report describes a mandibular angle fracture following removal of a fully impacted lower third molar of a 41 years old male patient. The fracture occurred 3 days after the attempt to extract the tooth 38 by a dentist surgeon. Several factors influencing the possibility of fracture including gender, age, dental position, and angulation were reviewed and associated with the injury. A fracture line in the angular region of the jaw was observed in radiological and tomographic analysis, both essential to perform the diagnosis. Open reduction internal fixation treatment approach was realized to ensure the best patient’s recovery. We conclude that the difficult to maintain a soft diet and the complete dentition factor could have been determinant to cause the fracture.Descriptors: Mandibular Fractures; Fracture Fixation; Molar, Third.ReferencesAl-Belasy FA, Tozoglu S, Ertas U. Mastication and late mandibular fracture after surgery of impacted third molars associated with no gross pathology. J Oral Maxillofac Surg. 2009; 67(4):856-61.daBodner L, Brennan PA, McLeod NM. Characteristics of iatrogenic mandibular fractures associated with tooth removal: review and analysis of 189 cases. Br J Oral Maxillofac Surg. 2011;49(7):567-72.Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007; 19(1):117-28.Joshi A, Goel M, Thorat A. Identifying the risk factors causing iatrogenic mandibular fractures associated with exodontia: a systemic meta-analysis of 200 cases from 1953 to 2015. Oral Maxillofac Surg. 2016;20(4):391-96.Libersa P, Roze D, Cachart T, Libersa JC. Immediate and late mandibular fractures after third molar removal. J Oral Maxillofac Surg. 2002;60(2):163-66.Perry PA, Goldberg MH. Late mandibular fracture after third molar surgery: a survey of Connecticut oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2000;58(8):858-61.Pires WR, Bonardi JP, Faverani LP, Momesso GAC, Muñoz XMJP, Silva AFM et al. Late mandibular fracture occurring in the postoperative period after third molar removal: systematic review and analysis of 124 cases. Int J Oral Maxillofac Surg. 2017;46(1):46-53.Krimmel M, Reinert S. Mandibular fracture after third molar removal. J Oral Maxillofac Surg. 2000;58(10):1110-12.Wagner KW, Otten JE, Schoen R, Schmelzeisen R. Pathological mandibular fractures following third molar removal. Int J Oral Maxillofac Surg. 2005;34(7):722-26.Ethunandan M, Shanahan D, Patel M. Iatrogenic mandibular fractures following removal of impacted third molars: an analysis of 130 cases. Br Dent J. 2012;212(4):179-84.Ellis E 3rd. Management of fractures through the angle of the mandible. Oral Maxillofac Surg Clin North Am. 2009;21(2):163-74.Pell GJ, Gregory GT. Report on a ten year study of a tooth division technique for removal of impacted teeth. Am J Orthodont Surg. 1942; 28:660-71.Antoun JS, Lee KH. Sports-related maxillofacial fractures over an 11-year period. J Oral Maxillofac Surg. 2008;66(3):504-8.Chrcanovic BR, Custódio AL. Considerations of mandibular angle fractures during and after surgery for removal of third molars: a review of the literature. Oral Maxillofac Surg. 2010; 14(2):71-80. Iizuka T, Tanner S, Berthold H. Mandibular fractures following third molar extraction. A retrospective clinical and radiological study. Int J Oral Maxillofac Surg. 1997;26(5):338-43.Woldenberg Y, Gatot I, Bodner L. Iatrogenic mandibular fracture associated with third molar removal. Can it be prevented?. Med Oral Patol Oral Cir Bucal. 2007;12(1):E70-2.Miyaura K, Matsuka Y, Morita M, Yamashita A, Watanabe T. Comparison of biting forces in different age and sex groups: a study of biting efficiency with mobile and non-mobile teeth. J Oral Rehabil. 1999;26(3):223-27.Bezerra TP, Studart-Soares EC, Pita-Neto IC, Costa FW, Batista SH. Do third molars weaken the mandibular angle?. Med Oral Patol Oral Cir Bucal. 2011;16(5):e657-63.Grau-Manclús V, Gargallo-Albiol J, Almendros-Marqués N, Gay-Escoda C. Mandibular fractures related to the surgical extraction of impacted lower third molars: a report of 11 cases. J Oral Maxillofac Surg. 2011;69(5):1286-90.

Purpose The management of atrophic mandibular fractures presents challenges due to the absence of stable occlusion and the insufficient bone volume. In this case series, we present a technique based on virtual surgical planning and in-house computer-aided design and manufacturing (CAD/CAM) for the surgical treatment of severe atrophic mandibular fractures. Methods etween 1 January 2022 and 31 December 2024, eight patients with edentulous mandibular fractures were treated. Data collected included age, gender, cause of mandibular fracture, degree of atrophy according to Luhr's classification, site and type of fracture according to Ellis and Price, mean virtual planning and operative time, number of osteosynthesis plates, length of hospital stay, adequacy of reduction according to Ramanathan, and clinical outcomes. Results Seven female and one male patient (mean age 82.6 ± 3.99 years; range 80-92) were included. Six patients were classified as having class III atrophy, and two as class II. Mild, moderate, and severe displacement were observed in three (37.5%), two (25%) and three (37.5%) patients respectively. Postoperative panoramic radiography demonstrated good and very good reduction in three (37.5%) and five (62.5%) patients respectively. Virtual surgical planning and plate pre-bending required an average of 90.5± 10.5 minutes. The mean operative time was 135.3 ± 6.63 minutes. Conclusion Virtual fracture reduction and plate pre-bending on stereolithographic models represent a valuable tool for managing severe atrophic mandibular fractures. The authors believe this approach has potential to improve operative accuracy and reduce surgical time in these complex cases, offering good cost-effectiveness and time efficiency.

Objective: The objective of current study was to evaluate the etiology, patterns of presentation, frequency and different treatment modalities for mandibular fractures in patients treated at Lahore Medical and Dental College/Ghurki Trust Teaching Hospital (LMDC/GTTH). Methodology: This descriptive – cross sectional study was conducted at Lahore Medical and Dental College, Lahore/Ghurki Trust Teaching Hospital (LMDC/GTTH) from March 2015 to September 2017. The current study included one hundred and twelve (112) patients who were indentified having mandibular fractures. Data were collected regarding patient’s age, gender, etiology, site of fracture, patterns and treatment modalities and analyzed using SPSS version 20. Results: The patients’ ages were between 3 to 55 years (24.87±10.867, mean/SD). The majority of fractures occurred amongst 21-30 years of age group having female to male ratio of 1:5.6. Road traffic accident (RTA) was the most frequent etiological factor for mandibular fractures in 89 (79.47%) of patients, followed by assaults 11(09.82%) and fall 07 (06.25%). A total of 189 fractures were recorded in 112 patients giving a mean of 1.7 fractures per patient. Out of 189 fractures, the parasymphysis was the most prominent site of mandibular fractures(43.39%), followed by condyle (22.75%) and angle (15.87%). The treatment modality of open reduction and internal fixation (ORIF/ORIF with IMF) was performed in 88(78.57%) of patients while closed reduction and indirect fixation (IMF with eyelet wiring/arch bar elastics &amp; splint fixation) was done in 24 (21.43%) of patients. Conclusion: As evidenced by the present study, road traffic accidents are the most common cause of mandibular fractures in young adults, mostly due to violation of traffic rules. These findings highlight the need to reinforce legislation for prevention of such injuries both in children and adults

WITHDRAWN: A Retrospective study of 186 mandibular angle fractures: Influence of mountainous topography on etiology of mandibular angle fracture

The aim of this study was to compare 2D plates with 3D miniplate system in the management of mandibular angle fractures. The study was conducted on 146 patients with mandibular angle fracture, who were equally divided into two groups of 73. Patients in group I were treated with 3D plating and in group II with 2D plating. In all cases, 2.0 mm titanium miniplates were used. The etiology of fracture, amount of mouth opening, and pain and sensory deficit were recorded. Clinical and radiographic assessment was done at 1, 3, and 6 months. The etiology of mandibular angle fracture is roadside accident (RSA) seen in 110 (75.3%) cases, fall in 24 (16.4%), and assault in 12 (2.6%) cases. There was significant (p < 0.05) mouth opening in group I at 1 month postoperatively (32.4 mm) as compared to group II (27.5 mm), at 3 months in group I (33.6 mm) as compared to group II (30.2 mm), and at 6 months in group I (36.4 mm) as compared to group II (31.6 mm). After 1 month, sensory deficit was present in six patients in group I and 10 patients in group II. After 3 months, group I had no patients and three patients in group II. Right angle fracture was found in 71 patients (group I-36, group II-35). Mandibular right angle fracture in 58 patients (group I-28, group II-30). The authors found that the 3D miniplate system is more useful in the management of cases of mandibular angle fracture as compared to 2D miniplates. There has been increase in mandibular fractures in the last few years. Appropriate management with 3D miniplates may be useful in providing better treatment outcomes.