The Prevalence and Distribution of Combination Fractures in the Mandible

Abstract

Introduction-Craniofacial reconstruction following trauma is different for each individual as it highly depends on the nature and location of the patient’s injuries. The mandible is a unique bone, which has a complex role in both esthetics of the face and functional occlusion. Due to the prominent position of the lower jaw, mandibular fractures are the most common fracture of the facial skeleton Aim- The aim of this study is to assess the prevalence and distribution of combination fractures in the mandible among patients presenting at the University of Limpopo, Medunsa Campus, department of Maxillofacial and Oral surgery. The nature and site of injuries occurring in the mandible will be recorded, and correlated with the cause of injury. The data should establish a preoperative idea of fractures that can be expected in the mandible when associated with a particular type of injury, especially of the combination type. Materials and methods- The patient’s records and radiographs at the University of Limpopo Medunsa Campus, Department of Maxillofacial and Oral Surgery (MFOS) were accessed. Patients with mandibular fractures who presented to the department over a four-year period (ranging from January 2002 to December 2005) were included in this study. Results- There were 1755 patients treated for maxillofacial injuries during the period 2002 to 2005 (4 years). A total of 1222 (69.63%) patients sustained fractures to the mandible. However 505 (41.33%) patients sustained combination fractures of the mandible. This evidence statistically proves that there is a 41.33% chance of another fracture occurring in a patient who has been diagnosed with a single fracture to the mandible. Various etiological factors contributed to these mandibular fractures. Interestingly the major contributing factor was found to be assault. This study confirms the results that males are affected more than females. This study found the average male to female ratio to be 8.18:1. The age distribution ranged from 2 years to 86 years. The mean age was found to be 31.07 years with a standard deviation of 12.06 years. The highest frequency was recorded between 20 to 29 years (42.77%) followed by 30 to 39 vi years (24.36%). The sites of fractures varied with different combinations. The highest number of fractures was recorded in the left angle (159) followed by the right parasymphysis region (142). In the combination category however the left angle right parasymphysis combination (70) showed the highest incidence of combination fractures followed by left parasymphysis and right angle combination (47), right angle and left body combination (37) and left angle and right body (36) combination fractures. The incidence of sustaining a left angle and right parasymphysis combination fracture is 13.86%. A total of 92 (18.22%) condyles sustained fractures with various combinations. Fifty fractures occurred on the left side while 42 occurred on the right side. Conclusion- In conclusion this study has shown that there is a 41.33% chance of a combination fracture occurring in a fractured mandible. These results are statistically high given the fact that the mandible is a commonly injured bone. Therefore careful evaluation of diagnostic radiographs is necessary since some fractures are not diagnosed clinically. This can help improve treatment outcomes and reduce possible postoperative complications.