Types Of Mandibular Fractures Research Articles

Temporomandibular joint degenerative changes following mandibular fracture: a computed tomography-based study on the role of condylar involvement.

This study assessed the incidence of postfracture radiological temporomandibular joint (TMJ) degeneration in patients with different types of mandibular fractures, focusing on the impact of condylar fractures. This retrospective review included patients diagnosed as having mandibular fractures from 2016 to 2020 who had undergone initial computed tomography (CT) and a follow-up CT scan at least 1-month postfracture. Patient demographics, fracture details, treatment methods, and radiological signs of TMJ degeneration on CT were analyzed to identify risk factors for postfracture TMJ degeneration, with a focus on condylar head fracture and non-head (condylar neck or base) fractures. The study included 85 patients (mean age: 38.95 ± 17.64years). The per-patient analysis indicated that the incidence of new radiologic TMJ degeneration on CT was significantly the highest (p < 0.001) in patients with condylar head fractures (90.91%), followed by those with non-head condylar fractures (57.14%), and those without condylar involvement (24.49%). The per-joint analysis indicated nearly inevitable degeneration (93.94%) in 33 TMJs with ipsilateral condylar head fractures. For the remaining 137 TMJs, multivariate logistic regression revealed that other patterns (ipsilateral non-head, contralateral, or both) of condylar fractures (odds ratio (OR) = 3.811, p = 0.007) and the need for open reduction and internal fixation (OR = 5.804, p = 0.005) significantly increased the risk of TMJ degeneration. Ipsilateral non-head condylar fractures and contralateral condylar fractures are associated with a high risk of postfracture TMJ degeneration. Indirect trauma plays a vital role in postfracture TMJ degeneration.

The Preference Treating of Comminuted Mandibular Fractures by The Close Reduction Over the Open Reduction Technique in Iraq Soldiers War Under Specific Factors

Aim of the study: The preforming study tended to point the using close reduction Inter maxillary fixation (CRIMF) as definite treatment for comminuted fracture of the mandible under certain conditions for managing same types of mandibular fractures with the evaluating and comparing the outcome and complications between two techniques.&#x0D; Materials and methods: (CRIMF) and (ORIF). A total of 51 patients with comminuted mandibular fractures, aged between (17-45) years. All patients were examined clinically,&#x0D; &#x0D; radio graphically (OPG) and some of them computed tomographically (CT3D) before and after treatment to evaluate the regions fracture position, and assessed the complication resulted post operatively. Patients were divided into 2 groups: Group A (n=30) patients with 36 fractures had managed by close reduction and indirect fixation using intra maxillary fixation (CRIMF). Group B (n= 21) patients with 24 fractures operated by open reduction internal fixation (ORIF) using reconstruction plates. Group A managed by maxilla mandibular fixation MMF were performed for 28 cases under general an anesthesia (GA) and only 2 patients fixed under local anesthesia. In the group B, all surgical operations of ORIF were done under GA.&#x0D; &#x0D;

Correlation of radiomorphometric indices of the mandible and mandibular angle fractures

This study assessed the correlation of radiomorphometric indices of the mandible and mandibular angle fractures (MAFs) in an Iranian population. This retrospective study was conducted on 3D computed tomography (CT) scans of 118 patients between 18 to 60 years. The images were divided into two groups with MAFs and other types of mandibular fractures (non-MAF). The gonial angle, ramus height, condylar neck width, minimum ramus width, and mandibular length were all measured using MARCO PACS software. Age, gender, and presence and eruption status of third molar at the fracture side were all recorded. The correlation between these parameters and MAF was analyzed using R software (alpha = 0.05). Of all patients, 41 samples had MAF. The two groups were not significantly different regarding the mean age and gender (P > 0.05). The mean size of gonial angle and ramus height in the MAF group were significantly larger, and smaller than the corresponding values in the non-MAF group, respectively (P < 0.001). The median minimum ramus width in the MAF group was significantly smaller than that in the non-MAF group (P = 0.001). Patients with a large gonial angle had 6.6 times higher odds of MAF compared with other fracture types (P = 0.046). Condylar neck width, mandibular length, and erupted third molars had no significant correlation with type of fracture. Presence of impacted third molar increased the odds of MAF by 5.55 times.Patients with a large gonial angle, short ramus height, minimum ramus width, and impacted third molar are more susceptible to MAF. Surgeons can use these indices to predict the risk of MAF in trauma patients with such facial characteristics, and make a diagnosis by radiographic modalities.

Occurrence and pattern of mandibular fractures in maxillofacial trauma of Kerala population

Objectives: Fracture of the mandible may affect a single anatomic site or frequently several sites concurrently and road traffic accidents (RTA) play a prominent role. The aim of this study was to analyze the patient demographics, etiology, pattern, and types of mandibular fractures in three northern districts of Kerala. Methodology: 81 patients with sustaining mandibular fractures who visited the Emergency Department of the Oral and Maxillofacial Surgery, Government Dental College, Thrissur, Kerala were recruited and evaluated retrospectively. The variables analyzed in the study were age, gender, etiology, fracture site, pattern, and types of fractures. The data were statistically analyzed using the Chi-square test to determine the association between the variables. Results: The study included 104 fractures in 81 patients. The ratio of males to females was 7.1:1. The highest fracture prevalence were observed in adults (88.9%) and the least in children under 12 years of age. RTA was the common cause (60.5%) followed by assault (27.2%). The most commonly reported fracture site was parasymphysis (24%), and the condyle (20.2%). The compound fractures were frequently observed (72%) and comminuted fractures (4%) were the least. A highly significant association was identified between the anatomic site and the severity of fracture types.

Could mandibular fractures lead to obstructive sleep apnea?

ABSTRACT Objective To detect and assess obstructive sleep apnea (OSA) before and after repair of different types of mandibular fractures. Methods In patients with traumatic isolated mandibular fractures who were indicated for open reduction and internal fixation (OR/IF), polysomnography (PSG) was done before and 3 months after surgery. Results Of 51 patients (80 mandibular fractures), fractures were unilateral in 29 patients (56.9%) and bilateral in 22 patients (43.1%). PSG was normal in 33 patients (64.7%), and OSA was detected in 18 cases (35.3%); all had bilateral fracture. Mild OSA was reported in 9 cases (17.65%), and moderate OSA was detected in 9 cases (17.65%). Three months after OR/IF of the fractures, successful reduction was obtained, and PSG was within normal limits in all patients. Conclusion Bilateral mandibular fractures often lead to OSA, which could be cured with proper OR/IF of the fractures. OSA is not encountered in unilateral fractures.

Incidence and Prevalence of Different Types of Mandibular Fractures- A University Dental Hospital Based Study

Incidence and Prevalence of Different Types of Mandibular Fractures- A University Dental Hospital Based Study

REHABILITATION IN MAXILLOFACIAL SURGERY AND DENTISTRY AFTER FRACTURE OF THE MANDIBLE

Fractures of the mandible are very common injuries, so modern authors are widely developing the latest approaches to surgical treatment of these types of injuries, as well as approaches to postoperative recovery of patients. Physical rehabilitation and therapy of persons after surgical treatment of mandibular fractures is of paramount importance in the process of recovery of patients, as it helps to restore lost functions and promotes the fastest recovery. In order to restore the process, special individual rehabilitation programs are developed, which depend on the nature of the injury, the patient’s condition and the methods used in the treatment process. In recent years, there has been a tendency to increase the number of patients with fractures of the facial skeleton, and to complicate the nature of injuries due to a combination of injuries to the face and other parts of the body as a result of transport, street, occupational, sports and domestic injuries. The article investigates approaches to the treatment and rehabilitation of patients after mandibular fracture. In particular, the features and types of mandibular fractures in maxillofacial surgery and dentistry are noted, the causes of their occurrence, methods of diagnosis and treatment are considered. It is noted that a very important stage of treatment and recovery of the body after fractures of the mandible is the physical rehabilitation of patients. Physical rehabilitation programs are developed individually depending on the nature of the fracture, and the characteristics of the patient’s body, usually the physical rehabilitation program includes exercise therapy, massage, mechano- and physiotherapy. It is noted that a professionally developed individual rehabilitation program has a positive effect on the patient’s condition and accelerates the process of recovery and recovery, so the issues explored in the article are relevant.

ОСТЕОСИНТЕЗ НИЖНЕЧЕЛЮСТНЫХ ПЕРЕЛОМОВ С ИСПОЛЬЗОВАНИЕМ КОНСТРУКЦИЙ ИЗ НИКЕЛИДА ТИТАНА

Цель. Разработка новой медицинской технологии хирургического лечения больных с переломами нижней челюсти с использованием материалов с памятью формы.Материалы и методы. С использованием фиксирующих конструкций из никелида титана с памятью формы, разработанных в НИИ медицинских материалов и имплантатов с памятью формы, выполнено оперативное лечение более 2000 больных, лиц обоего пола, в возрасте от 13 до 80 лет, с переломами нижней челюсти различного характера и локализации из внутриротового или внеротового доступов без иммобилизации нижней челюсти и комбинации с другими способами остеосинтеза.Результаты. Применение фиксирующих конструкций с термомеханической памятью в хирургическом лечении различных типов переломов нижней челюсти позволило получить удовлетворительные результаты у 95,5% больных. В остальных 4,5% случаях возникли осложнения в виде нагноения костной раны, травматического остеомиелита, что связано с поздними обращениями и/или угнетением репаративной функции, замедленная консолидация, в основном у лиц старшего и пожилого возраста, в результате трофических нарушений.Заключение. Благодаря биосовместимости никелида титана с тканями организма остеосинтез переломов нижней челюсти с использованием скоб из данного материала позволяет свести до минимума все виды осложнений, присущие этому типу вмешательств.

Lag Screw Technique for Treating a Mandibular Angle Fracture: Case Report

The treatment of mandibular angle fractures involves several postsurgical complications and is in greater demand when compared to therapeutic approaches for other types of mandibular fractures. Such postsurgical complications as bleeding, swelling, infection, dehiscence, pseudoarthrosis and paresthesia might affect individuals in both sexes and at all age groups. The presence of a mandibular third molar, a cross-sectional area thinner than the tooth-bearing region, and biomechanical forces might hamper the surgery, making it longer and more complex. Internal fixation is aimed at undisturbed healing under condition of functional and without any period of intermaxillary fixation. Adequate fixation depends on different fracture types, patients' general health and compliance, and the timing of the operation. This case report involves a mandibular angle fracture successfully treated with the lag screw technique, a simple approach to treat one of the most common fractures involving the mandible, quickly restoring the patient ́s oral functions.

Evaluation of Titanium Lag Screw Osteosynthesis in the Management of Mandibular Fractures

ABSTRACT Introduction The management of facial trauma is one of the most important and demanding aspects of maxillofacial surgery. Mandible is the most movable and prominent bone of facial skeleton. The management of the injuries to the maxillofacial complex remains a challenge for oral and maxillofacial surgeons. The aim of mandibular fracture treatment is the restoration of anatomical form and function with particular care to establish occlusion. The lag screw technique was first introduced to maxillo facial surgery by Brons and Boering in 1970, who cautioned that at least two lag screws are necessary to prevent rotational movement of the fragments in oblique fractures of mandible. Aim The aim of the study was to evaluate the outcome of lag screw osteosynthesis in the management of mandibular body, symphysis, and parasymphysis fractures. Materials and methods About 15 cases presenting with mandibular oblique, sagittally displaced mandibular fractures, and requiring open reduction and internal fixation (ORIF) were selected. Titanium lag screws were placed in such a way that their axes bisect the angle between a perpendicular drawn to the fracture line and perpendicular to the bone surface. About 3 months postoperatively, follow-up was done to evaluate the duration of surgery intraoperatively, stability of fracture segments, occlusion, biting efficiency postoperatively, and record any postoperative complications with lag screw fixation technique. Results The maximum intraoperative time was 120 minutes and minimum was 40 minutes. The average intraoperative time was 72 minutes. In postoperative complications, deranged occlusion was seen in two patients; in one patient, it was due to associated condylar fracture and technical error in the placement of lag screw in another patient; but, it was not significant statistically with a p-value of 0.483 and which was managed easily by placing guiding elastics for 2 weeks in both patients. All the patients in the study showed good stability of fixation and significant increase in biting efficiency over a period of time. No postoperative complications, such as lag screw exposure, neurosensory disturbance, and malunion/nonunion were seen in any of the patients. Conclusion Titanium lag screw fixation was found to have good stability, rigidity, was inexpensive, and less time consuming in some types of mandibular fractures, though there exist few contraindications regarding its usage. This technique is a very sensitive procedure, requiring strict adherence to the lag screw placement principle and sufficient knowledge about the surgical anatomy of the mandible. Clinical significance Fixation of the anterior mandible fracture using this technique can achieve good stability and appropriate compression. The technique reduces the chances of infection due to less exposure and promotes the healing process by producing stress in the fracture lines. Lag screw showed faster improvement in terms of biting efficiency and a significant reduction in fracture gap, which is not seen in miniplate fixation. How to cite this article Bansal P, Kumar S, Mishra V, Jaiswal Y, Das G. Evaluation of Titanium Lag Screw Osteosynthesis in the Management of Mandibular Fractures. World J Dent 2017;8(4):315-320.

A Two-Year Prospective Analysis of Mandibular Fractures in Western Population of Maharashtra, India

Introduction: Trauma to the facial region causes injuries to hard and soft tissues of the face. Injuries to the maxillofacial region are increasing in frequency and severity because of the increased number of road traffic accidents (RTAs) and increased number of violence. The purpose of this study was to evaluate age, gender distribution, etiology, and pattern of mandibular fractures in Western part of Maharashtra population. Materials and Methods: The study was conducted in the Department of Oral Medicine and Radiology for a period of two years from June 2013 to June 2015. Clinical examination of all trauma patients was done and diagnosis was made based on signs, clinical features, and confirmed by orthopantomographs. Results: Totally, 193 patients were detected with different types of mandibular fractures. Study group involved 77.2% males and 22.8% females with a male to female ratio of 3.3:1. Majority of patients were in the age group of 21–30 years followed by 31–40 years. Trauma due to RTAs were more common followed by assaults and fall. Parasymphyseal fractures were most common type followed by condylar fracture and fracture of angle of mandible. Conclusion: Males were most commonly affected by trauma than females with a predominant age group of 21–30 years. Majority of trauma were due to RTAs with parasymphyseal as most common type of fracture.

Mandibular Fractures and Associated Factors at a Tertiary Care Hospital.

ObjectivesThe aim of this study was to evaluate the distribution, etiology and type of mandibular fractures in subjects referred to our institution.MethodsA retrospective study of 689 subjects, during the period from May 2010 to September 2013 with mandibular fractures was conducted. Information on age, gender, mechanism of injury and sites of trauma was obtained from the trauma registry. Data were tabulated and analyzed statistically.ResultsA total of 653 subjects had mandibular fractures, out of which 574 were males. The mean age of the participants was 31.54 ± 13.07. The majority of the subjects were between 21-40 years of age, in both males (61.7%) and females (54.4%). The major cause of fractures was road traffic accidents (87.4%) followed by fall (6.9%) and assault (4%), with the least frequent being gunshot injuries (0.3%). Almost half of the patients had parasymphysis fractures (50.2%), followed by angle (24.3%), condyle (20.4%), ramus (2.3%) and coronoid (2%). A total of 115 patients had bilateral fractures out of which 29 had parasymphysis, 12 had body fractures and 74 had bilateral condylar fractures. Double mandibular fractures were reported in 193 subjects; out of which 151 subjects had double contralateral and 42 had double unilateral fractures. Triple unilateral fracture was reported in only one subject. A total of 338 subjects had multiple fractures among the study population.ConclusionsMandibular fractures can be complicated and demanding, and have a compelling impact on patients’ quality of life. Our study reported that parasymphysis was the most common region involved in mandible fractures.

Association between eruption state of the third molar and the occurrence of mandibular angle fractures.

Fractures of the mandible, especially the mandibular angle, are one of the most frequent types of injuries of the facial skeleton. In many cases, a retained third molar can be found in the line of the fracture. However, it remains unclear whether a relationship between third molars and mandibular angle fractures exists. Patients with isolated or combined fractures of the lower jaw between January 2001 and December 2007 were analyzed retrospectively. Electronic health records were investigated regarding the types of mandibular fractures, and panoramic radiographs were reviewed concerning the existence of third molars. In addition, a systematic review was performed to compare the findings of this study with existing data. Six hundred and thirty-two patients were treated for mandibular fractures within the time frame. Two hundred and sixty-seven had a mandibular angle fracture. In 461 patients, panoramic radiographs were available, of which 45.6% did not have a third molar. About 3.8% were edentulous. There is a significant relationship between the existence of unerupted third molars and the occurrence of mandibular angle fractures (P < 0.001). No correlation exists for erupted third molars. Fractures of the mandibular angle are more likely to appear in patients with retained third molars which might be due to the reduced bone mass. Once the wisdom teeth have erupted, the bone structure is more solid and more resistant to external forces and the development of fractures.

Profile of mandibular fractures in a tertiary care hospital: Retrospective institutional study

Aim: To evaluate the distribution, etiology, and type of mandibular fractures in the subjects reported to our institution. Materials and Methods: A retrospective study of 689 subjects reported during the period from May 2010 to September 2013 with mandibular fractures was conducted. Information on age, gender, mechanism of injury and sites of trauma was obtained from the trauma registry. Data were tabulated and analyzed statistically. Results: A total of 653 subjects had mandibular fractures out of which 574 were males. The mean age of the participants was 31.54 ± 13.07. The majority of the subjects' age were in the range of 21–40, in both males (61.7%) and females (54.4%). The major cause for the fractures was road traffic accidents (87.4%) followed by fall (6.9%), assault (4%) with least being gunshot injuries (0.3%). Almost half of the patients had parasymphysis fractures (50.2%), followed by an angle (24.3%), condyle (20.4%), ramus (2.3%), and coronoid (2%). A total of 115 patients had bilateral fractures of which 29 had parasymphysis, 12 had body fractures, and 74 had bilateral condylar fractures. Double mandibular fractures were reported in 193 subjects, of which 151 subjects had double contralateral, and 42 had double unilateral fractures. The triple unilateral fracture was reported by only one subject. A total of 338 subjects had multiple fractures among the study population. Conclusion: Mandibular fractures can be complicated, demanding and have a compelling impact on patients' quality of life. Our study has reported that parasymphysis was the most common region involved in mandible fractures.

Management of unusual types of mandibular fractures in the dromedary camels

Twenty eight camels of both sexes had un usual mandibular fractures. These were 14 males and 14 females, age between 1- 7 years or older. The site of fractures was at the horizontal rami either unilateral or bilateral or at the vertical ramus of mandible. Longitudinal fractures were also encountered splitting the incisors apart. Oblique unilateral fractures were not uncommon. Bilateral comminuted fractures occurring at horizontal rami resulted in mal- occlusion. The fractures were treated using cerclage or hemi-cerclage wires combined with cortical screws, using copper wire or with plates and screws.

A New and Easy Technique of Maxillomandibular Fixation in Treatment of Mandibular Fractures

The present work evaluated the success of maxillomandibular fixation (MMF) by a new and simplified technique in management of minimally displaced mandibular fractures. A total of 20 patients who sustained various types of mandibular fractures were treated at the Government Dental College, Rohtak, India by a new MMF technique. The patients were evaluated by preoperative and postoperative radiography, and clinical testing was performed to assess the degree of tooth mobility adjacent to the site of MMF. The time required for MMF was also noted. Patient recovery was uneventful in all 20 cases, and the period of MMF ranged from 2 to 4 weeks (mean 21 days). The outcome was good. The mean time for performing MMF was 12 minutes (range, 10 to 15 minutes). It is a simple, quick, economical, and minimally invasive technique. Its mechanical principle provides an advantage in preventing postoperative periodontal problems.

Maxillomandibular Fixation Using Intraoral Cortical Bone Screws and Specially Designed Metal Hooks (Ottenhaken) in the Conservative Treatment of Mandibular Fractures

The present work evaluated the success of maxillomandibular fixation (MMF) by intraoral cortical bone screws and specially designed metal hooks (Ottenhaken) in nondislocated or slightly dislocated mandibular fractures. A total of 44 patients who sustained various types of mandibular fractures were treated at the University Hospital for Craniomaxillofacial and Oral Surgery, Vienna Medical School by MMF with Ottenhaken only. The patients were evaluated by preoperative and postoperative radiography, and clinical testing was performed by thermal testing with a cold spray and by assessing the degree of tooth mobility adjacent to the inserted screws. To determine the success of the treatment, various parameters, including screw or hook fracture, screw loosening, local infection of the punctured mucosa, and iatrogenic tooth damage, were considered. The screws and hooks were successfully inserted and MMF was engaged with tight elastics in all cases. The most frequent complication was rupturing of the elastics, necessitating replacement. In 5 patients, local infection of the mucosa around the screw led to severe pain that was treated successfully with analgesics. The screws could be left in place in all 5 cases. Hook fracture and screw loosening each occurred in 1 patient. No iatrogenic injuries of the dental roots were noted. After screw removal, all wounds healed uneventfully. The use of intraoral cortical bone screws and specially designed metal hooks (Ottenhaken) for MMF is a useful, valid alternative to arch bars that carries only rare, mild complications.

Panfacial Fractures: Analysis of 33 Cases Treated Late

The aim of this retrospective study was to analyze the characteristics of delayed panfacial fractures and evaluate treatment results. Thirty-three patients with delayed panfacial fractures were treated in the Maxillofacial Trauma Center of Peking University, School and Hospital of Stomatology between 1998 and 2004. Each patient was examined by computed tomography (CT) scans before operation. For those who had no severe opening restriction, dental impressions were taken to fabricate dental casts. For those with severely comminuted fractures, 3-dimensional (3D) models of the facial skeleton were used. Re-establishing the continuity of the mandible was the first step and then used as a platform to reconstruct the maxillary fractures via maxillomandibular fixation after Le Fort I osteotomy. The third step was to restore the mid- and upper-facial width and projection by coronal approach to expose the zygomatic complex and frontal bone/sinus and/or naso-orbito-ethmoid (NOE) fractures. There were 3 types of mandibular fractures that affected the treatment plan: 1) type I, mandibular body/symphysis fracture(s) (17/33, 51.52%); 2) type II, mandibular angle and/or condylar fracture(s) (6/33, 18.18%); and 3) type III, both mandibular body/symphysis and angle/condylar fractures (10/33, 30.30%). Fourteen cases were associated with NOE fractures (42.42%) and 3 cases had frontal sinus fractures (9.1%). Twelve cases had enophthalmos (36.36%) and 3 lost 1 eyeball. The order of treatment was dependent on the mandibular fracture type. For type I fractures, reconstructing the mandibular arch was the first step. For type II fractures, repairing the angle, ascending rami, and condylar areas was the first step. For type III fractures, when both mandibular height and arch were disrupted, freeing the malunited angle or condyle was the first step before restoring the mandibular arch form. Reconstruction of the mandibular height and projection was then carried out. For all 3 types, the second step was to restore the mid- and upper facial width and projection by reducing the zygomatic complex and frontal bone/sinus or NOE fractures. Maxillary fixation across the Le Fort I level was the last step. Le Fort I osteotomy was used for all 33 cases. Bone grafts and soft tissue suspension also were used. Twenty-one cases (63.64%) had good results, 7 (21.21%) cases were acceptable, and 5 (15.15%) were not good. There were 7 cases (21.21%) that still had soft tissue problems that needed secondary operations. Reconstruction of the mandible first with Le Fort I osteotomy is a good way to treat delayed panfacial fractures. Computed tomography and 3D CT, model surgery, and occasionally 3D models are necessary aids for diagnosis and treatment. Soft tissue problems, including lacerations and asymmetries, were often the factors that caused an unfavorable outcome.

5196 Mandible Fractures Among 4381 Active Duty Army Soldiers, 1980 to 1998

We present the frequencies of various types of mandibular fractures along with associated mechanisms and injuries. Retrospective analysis of 5196 mandible fractures in 4381 patients extracted from the Total Army Injury and Health Outcomes Database (TAIHOD), a comprehensive database developed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) that links population data to all hospitalizations among active duty army soldiers. The database is based on the ICD-9 CM coding system. We found the following frequencies for specific mandible fracture locations: angle 35.6%, symphysis 20.1%, subcondylar 14.2%, body 12.7%, condylar process 9.1%, ramus 4.5%, alveolar border 2.7%, and coronoid process 1%. The mechanisms of injury were separated into seven categories. Fighting accounts for 36.2%, automobile accidents for 18.6%, athletics for 13.6%, falls for 9.7%, motorcycle accidents for 3.1%, other land transport accidents for 3%, and miscellaneous causes for 15.8%. A few fracture locations appear to be associated with specific mechanisms. Of 82 alveolar border fractures with known mechanisms, 37% resulted from automobile accidents. Of 1094 angle fractures with known mechanisms, 48.6% resulted from fighting. Our data show that the majority of fractures were isolated to one location. Only one fracture was recorded for 70.6%, 29.2% have two fractures recorded, 0.2% have three or more fractures recorded. Associated injuries were common and include facial lacerations 1236 (28.2%), non-mandible facial bone fractures 733 (16.7%), intracranial injury 403(9.2%), internal injuries 229 (5.2%), fractures of the upper limb 295 (6.7%), fractures of the lower extremity 302 (6.9%), and cervical fractures 34 (0.8%). The mechanism of injury is important in determining the most likely resultant mandible fracture in the case of angle of mandible and alveolar ridge fractures. The clinician should maintain a high level of suspicion for associated injuries that occur more than one fourth of the time and even more frequently in motor vehicle accident victims. Associated intracranial injury is particularly important to rule out. Associated facial fractures, intracranial injury, internal injuries, and extremity injuries are all more common than cervical fractures.

ミニプレートによる顎顔面骨骨折の治療

This report describes the application of technique for miniaturized screwed osteosynthesis plates inmaxillo-facial surgery. This plate is easily shaped and moulded using modeling pliers or byhand, so it can be adapted to almost all facial bone surfaces. During the past 3 years, 28 patients for 49 maxillo-facial fractures have been treated by this technique. This technique can be used for many types of mandibular fractures, including fractures of condyle, zygomatic complex fractures, and upper or lower orbital rim fractures. This technique has the following advantages: (1) the surgical approach is simple with small incisions, (2) inter-maxillary fixation is hardly necessary, (3) the technique is apPlicable to almost all facial bone fractures with small bone fragments, and (4) the necessity for removing the plates is greatly reduced. We have not encountered any complications or side effects.