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Table of Contents   
EPIDEMIOLOGICAL WORK  
Year : 2020  |  Volume : 31  |  Issue : 6  |  Page : 971-974
Prevalence of mandibular fractures


1 Department of Oral Medicine and Radiology, Karpagavinayaga Institute of Dental Sciences, Chennai, Tamil Nadu, India
2 Department of Oral and Maxillofacial Surgery, Karpagavinayaga Institute of Dental Sciences, Chennai, Tamil Nadu, India
3 Department of Conservative Dentistry and Endodontics, Sree Balaji Dental College, Pallikaranai, Chennai, Tamil Nadu, India
4 Department of Conservative Dentistry and Endodontics, Tagore Dental College, Rathinamangalam, Chennai, Tamil Nadu, India

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Date of Submission31-Mar-2018
Date of Decision25-Jan-2020
Date of Acceptance14-Jul-2020
Date of Web Publication22-Mar-2021
 

   Abstract 


Aim: The aim of this study was to determine the etiology, dissemination of mandibular fractures among different age, gender, and to determine the frequency of anatomic distribution in patients who reported to our institution from February 2015 to September 2015. Materials and Methods: All patients who fulfilled the selection criteria and had mandible fracture were selected for the study. The values were subjected to Z and Chi-square tests. Results: Out of 50 patients, 44 were male patients (88%) and 6 were female patients (12%). We found a peak occurrence of fractures in young adults, with mean age of 36 years. In case of etiology of fracture, road traffic accident was the most common (72%) and parasymphysis was most frequently involved site (n = 13.26%). Conclusion: In this study, the prevalence of mandibular fracture was more prevalent in male patients, especially during the third decade of life. The most common cause was road traffic accident and the more frequently affected region was parasymphysis of the mandible.

Keywords: Mandibular fracture, maxillo-facial fractures, parasymphysis, RTA, trauma

How to cite this article:
Saravanan T, Balaguhan B, Venkatesh A, Geethapriya N, Goldpearlinmary, Karthick A. Prevalence of mandibular fractures. Indian J Dent Res 2020;31:971-4

How to cite this URL:
Saravanan T, Balaguhan B, Venkatesh A, Geethapriya N, Goldpearlinmary, Karthick A. Prevalence of mandibular fractures. Indian J Dent Res [serial online] 2020 [cited 2021 Aug 2];31:971-4. Available from: https://www.ijdr.in/text.asp?2020/31/6/971/311649



   Introduction Top


Injuries of the maxillofacial complex represent one of the most important health problems worldwide.[1] The mandible is a unique bone having a complex role in esthetics of the face and functional occlusion. Because of the prominent position of the lower jaw, mandibular fractures are the most common fractures of facial skeleton. It has been reported that fractures of the mandible account for 36% to 59% of all maxillofacial fractures.[2] Despite the fact that it is the largest and strongest facial bone, it is the 10th most often injured bone in the body[3] and second to nasal bone fractures.[4] It is fractured two or three times more often than the other facial bones.[5]

Many causes of cranio-maxillofacial fractures have been reported, including road accidents, assaults, sporting injuries, falls and industrial accidents and even attack by animals.[6] Studies have shown that assaults are the predominant cause of maxillofacial fractures in developed countries, while motor vehicle accidents are the most common cause in developing countries.[7]

The aim of this study is to determine the etiology, dissemination of mandibular fractures among different age groups, gender distribution, and the frequency of anatomic distribution in patients who reported at our institution from February 2015 to September 2015.


   Materials and Methods Top


This was a cross-sectional study in a rural population which included all cases of mandibular fractures that were clinically and radiographically diagnosed and treated at our institution from February 2015 to September 2015. Patients with age group ranging from 20 to 60 years and of either sex were included. Patients who had refused to participate in the research or were medically compromised were excluded from the study.

Patient information was collected by means of a medical data form specifically designed for the present study. The data collected included age, gender, etiology of fractures, and anatomy of the fractures.


   Results Top


Fifty patients included in the present study were divided into groups according to age (20–30 years, 31–40 years, 51–60 years) and according to gender. Mechanism of injury was recorded and classified as RTA (road traffic accidents), falls, motor vehicle injuries, assault, and giddiness. Anatomically mandibular fractures were classified into 7 regions: Symphysis, parasymphysis, body, angle, ramus, coronoid, and condylar.

The sample size of the study is 50. Among them 44 were males and 6 were female accounting to 88% and 12%, respectively [Table 1] and [Figure 1].
Table 1: Gender distribution of mandibular fractures

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Figure 1: Gender prevalence of mandibular fractures

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The age of patients involved in this study ranged from 20 to 60 years.

People in the younger age group, in their third decade of life were more prone to accidents than elder people. The mean age is 36 years [Table 2] and [Figure 2].
Table 2: Age distribution of mandibular fractures

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Figure 2: Age distribution of mandibular fractures

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Among the 50 participants, 36 (72%) of them met with road traffic accidents, 8 (16%) of them had assault, nearly 5 (10%) of them fell either from their two wheeler or from steps. Only one patient had fracture due to giddiness, who in addition, also had a history of high blood pressure [Table 3] and [Figure 3].
Table 3: Type of assault

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Figure 3: Etiological factors of mandibular fractures

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Among the 50 study participants, 33 (66%) of them had alcohol during driving, which is the major cause for accidents and fracture [Table 4] and [Figure 4].
Table 4: Influence of alcohol

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Figure 4: Influence of alcohol consumption

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Most of them had single fracture 29 (58%) and nearly 21 had multiple fractures (42%) [Table 5] and [Table 6]. Among single site fractures, parasymphysis (44.83%) was more prevalent followed by the combination of angle and parasymphysis which was 42.86% [Table 6] and [Table 7].
Table 5: Prevalence of single site mandibular fractures

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Table 6: Prevalence of multiple sites in mandibular fractures

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Table 7: Classification of mandibular fractures based on site

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Chi square test was done to find the association between the variables, P < 0.05 is considered as significant.

There was significant association between drinking alcohol and the accidents with chi square value = 14.28, P = 0.00, as well as between gender and the accidents with chi square value = 15.54, P = 0.004 [Table 8], wherein age was not associated significantly with accidents [Table 9].
Table 8: Comparative evaluation of gender among various types of fall

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Table 9: Comparative evaluation of age among various types of fall

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   Discussion Top


The maxillofacial region is highly vulnerable to injuries during trauma and its occurrence is approximately 5–33% with the mandible being the most commonly involved site accounting for 12%. The sheer pace of modern life as well as an increasingly aggressive and intolerant society has made facial trauma a form of social disease to which no one is immune particularly the youth.

The mandible is the only movable bone of the maxillofacial complex, whereas the remaining portion is part of the fixed facial axis. Fracture in the mandible is never left unnoticed because it is symptomatic and the pain worsens with mastication, phonetics and even during respiratory movements accompanied by facial asymmetry.

Mandibular fractures may lead to deformities caused by displacement or non-restored bone loss, also affecting the dental occlusion or temporomandibular joint. If not identified and appropriately treated, these lesions may lead to severe sequelae, exerting its impact on both cosmetics as well as function.

In present study, the predominance of mandibular fractures in males (88%) is more than females (12%). The predominance of injured males in the younger age group may be attributed to the fact that in this period of life, people are more active in sports, violent activities, occupational injuries and high-speed transportation. Males are more exposed, due to their more frequent participation in high risk activities, such as driving vehicles, sports that involve physical contact, an active social life, interpersonal violence, drugs, alcohol, etc.

The high number of maxillofacial injuries in RTA is explained by an inadequate road safety awareness among the public; unsuitable road conditions; violation of speed limit; old vehicles without safety features-”such as antiburst locks and energy absorbing materials; failure to wear seatbelt or helmets which shows their negligence; widespread disregard for traffic rules; violation of the highway code; use of alcohol or of other intoxicating agents; inexperienced, young drivers and behavioral disorders.

Among the 50 participants, 36 (72%) had been involved in a road traffic accidents, 8 (16%) had been assaulted, and five had either fallen down steps or off their two wheeler. One patient suffered a fracture after a fall resulting from giddiness. Among the 50 study participants 33 (66%) of them had been driving after consuming alcohol, which is a major cause of accident and fracture.

Most of them had a fracture at a single site with the most common being at the parasymphysis accounting to 29 (58%). Nearly 21 had multiple fractures (42%) among which, angle and parasymphysis were more prevalent 9 (18%).

Sunita Malik et al.[8] also reported parasymphysis as the most common site of fracture in the mandible [Table 7]. However, our study was not consistent with the findings of Adekeye,[9] Nair[10] and Adebayo.[11] who reported the body as the most prominent site, whereas Van Beek[12] found the condyle as the most common site, and Chalya et al.[13] stated the angle as the most prominent site of fracture.

Several treatment modalities are available for mandibular fractures. The treatment plan varies according to the site and extent of the fracture.[14],[15],[16],[17] Open reduction and internal fixation is considered as the “gold standard” for maxillofacial fractures. Patients who reported to us were managed by open reduction and semirigid fixation. This treatment corrects malocclusion, nonunion, improves mouth opening, speech, and oral hygiene, thereby restoring form, function, and esthetics.

Post-operative assessment was done for the presence of infection, paresthesia, malunion, and wound dehiscence. No case was reported with post-operative complications.


   Conclusion Top


In the present study, road traffic accidents were reported to be the major etiological factor of maxillo-facial injuries with young adult males as their main victims especially during the third decade of life. The more frequently affected region was parasymphysis of the mandible. Open reduction and semirigid fixation have been the commonly used fracture management techniques. Since, the major cause of trauma proved to be motor vehicle accidents (MVAs), any effort made to enforce traffic and safety rules on the roads should be strictly followed and it is the only effective measure to prevent such untoward incidents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Brasileiro BF, Passeri LA. Epidemiological analysis of maxillofacial fractures in Brazil: A 5 – year prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:28-34.  Back to cited text no. 1
    
2.
Shah AA, Salam A. Pattern and management of mandibular fractures: A study conducted on 264 patients. Pakisthan Oral Dent J 2007;27:103-5.  Back to cited text no. 2
    
3.
Sirimaharaj W, Pyungtanasup K. The epidemiology of mandibular fractures treated at Chiang Mai university hospital: A review of 198 cases. J Med Assoc Thai 2008;91:868-74.  Back to cited text no. 3
    
4.
Olosoji HO, Tahir A, Arotiba GT. Changing picture of facial fractures in Northern Nigeria. Br J Oral Maxillofacial Surg 2008;46:126-7.  Back to cited text no. 4
    
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Subashraj K, Ramkumar S, Ravintharan C. Pattern of mandibular fractures in Chennai, India. Br J Oral Maxillofacial Surg 2008;46:126-7.  Back to cited text no. 5
    
6.
Al Khateb T, Abdullah FM. Cranio maxillofacial injuries in United Arab Emirates; A retrospective study. J Oral Maxillofacial Surg 2007;65:1094-101.  Back to cited text no. 6
    
7.
Dongas P, Hall GM. Mandibular fractures patterns in Tasmania, Australia. Aust Dent J 2002;47:131-7.  Back to cited text no. 7
    
8.
Malik S, Singh V, Singh G. Analysis of maxillofacial trauma at Rohtak (Haryana), India: Five years prospective study. J Maxillofac Trauma 2012;1:43-50.  Back to cited text no. 8
    
9.
Adekeye EO. The pattern of the fractures of the facial skeleton in Kaduna, Nigeria: A survey of 1447 cases. Oral Surg Oral Med Oral Pathol 1980;49:491-5.  Back to cited text no. 9
    
10.
Nair BK, Paul G. Incidence and aetiology of maxillofacial skeleton in Trivandrum- A retrospective study. Br J Oral Maxillofac Surg 1986;24:40-3.  Back to cited text no. 10
    
11.
Adebayo ET, Ajike OS, Adekeye EO. Analysis of the pattern of Maxillofacial fractures in Kaduna, Nigeria. Br J Oral and Maxillofac Surg 2003;41:396-400.  Back to cited text no. 11
    
12.
Van Beek GJ, Merkx CA. Changes in the pattern of fractures of the maxillofacial skeleton. Int J Oral maxillofac Surg 1999;28:424-8.  Back to cited text no. 12
    
13.
Chalya PL, Mchembe M, Mabula JB, Kanumba ES, Gilyoma JM. Etiological spectrum, injury characteristics and treatment outcome of maxillofacial injuries in a Tanzanian teaching hospital. J Trauma Manag Outcomes 2011;5:7.  Back to cited text no. 13
    
14.
Shahim FN, Cameron P, Mc Neil JJ. Maxillofacial trauma in major trauma patients. Aust Dent J 2006;51;225-30.  Back to cited text no. 14
    
15.
Patrocinio LG, Patrocinio JA, Borba BH, Bonatti BD, Pinto LF, Vieira JV, et al. Mandibular fractures: Analysis of 293 patients treated in the hospital of clinics, Federal university of Uberliandia. Braz J Otorhinolaryngol 2005;71:560-5.  Back to cited text no. 15
    
16.
Chandrashekar BR, Reddy C. A five year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated at 2 hospitals of Mysore city. Indian J Dent Res 2008;19:304-8.  Back to cited text no. 16
    
17.
Dibaie A, Raissian S, Ghafarzadeh S. Evaluation of maxillofacial traumatic injuries of forensic medical center of Ahwaz, Iran. In 2005;25:79-82.  Back to cited text no. 17
    

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Correspondence Address:
Dr. A Venkatesh
Department of Conservative Dentistry and Endodontics, Sree Balaji Dental College, Narayanapuram, Pallikaranai, Chennai - 600 100, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_286_18

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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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