MANAGEMENT PROTOCOL OF MANDIBULAR FRACTURES AT PAKISTAN INSTITUTE OF MEDICAL SCIENCES, ISLAMABAD, PAKISTAN.
Abstract
Background: Maxillofacial trauma is very frequent and associated with a high incidence ofmandibular fractures. Although there is universal agreement as to the treatment goals and basic
therapeutic principles of reduction and stabilization, a variety of currently accepted treatment
modalities indicate a lack of consensus. The authors evaluate the incidence, etiology, management
and complications of 344 mandibular fractures in 228 patients treated in the Department of Plastic
and Reconstructive Surgery at Pakistan Institute of Medical Sciences (PIMS), Islamabad,
Pakistan, during a three year period. Indications and techniques for closed and open treatment of
mandibular fractures are reviewed along with any complications of these fractures or their
management. Methods: A total of 344 mandibular fractures in 228 patients were included in this
study. The sex, age, etiology, presentation, fracture characteristics, associated injuries, various
methods of management and any pre or postoperative complications were evaluated. Results:
Although various devices and techniques have been used to treat these fractures, modern plate and
screw fixation systems have proved to provide the best rigid stabilization, early mobility and
associated with least complications. There was a satisfactory bone healing in all the patients and a
minimal complication rate associated with open reduction and internal fixation (ORIF).
Conclusion: Mandibular fractures occur with high frequency in road traffic accidents and
interpersonal violence. They are among the most common types of facial fractures treated by the
plastic surgeons. They must be managed carefully to maintain the function of the mandible, reestablish proper occlusion, and minimize secondary complications. Open reduction and internal
fixation has proven to be the most effective method for treatment of mandibular fractures.
Key Words: Maxillofacial; Trauma; Fracture; Mandible; Management
References
Chrcanovic BR, Freire-Maia B, Souza LN, Araújo VO,
Abreu MH. Facial fractures: a 1- year retrospective study in a
hospital in Belo Horizonte. Braz Oral Res 2004; 18(4): 322-
Hussain SS, Ahmad M, Khan MI, Anwar M, Amin M, Ajmal
S et al. Maxillofacial trauma: current practice in management
at Pakistan Institute of Medical Sciences. J Ayub Med Coll
Abbottabad 2003; 15(2):8-11.
Abbas I, Ali K, Mirza YB. Spectrum of mandibular fractures
at a tertiary care dental hospital in Lahore. J Ayub Med Coll
Abbottabad 2003; 15(2): 12-4.
Muzaffar K. Management of maxillofacial trauma. AFID
Dent J 1998; 10:18-21.
Bataineh AB. Etiology and incidence of maxillofacial
fractures in the north of Jordan. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 1998; 86(1): 31-5.
Lawoyin DO, Lawoyin JO, Lawoyin TO. Fractures of the
facial skeleton in Tabuk North West Armed Forces Hospital:
a five year review. African J Med Med Sci 1996; 25(4): 385.
Edwards TJ, David DJ, Simpson DA, Abbott AA. Patterns of
mandibular fractures in Adelaide, South Australia. Aust N Z
J Surg 1994; 64(5): 307-11.
Tanaka N. Tomitsuka K, Shionoya K, Andou H, Kimijima Y,
Tashiro T et al. Aetiology of maxillofacial fracture. Br J Oral
Maxillofac Surg 1994; 32(1): 19-23.
Ugboko V, Udoye C, Ndukwe K, Amole A, Aregbesola S.
Zygomatic complex fractures in a suburban Nigerian
population. Dent Traumatol 2005; 21(2): 70-5.
Kontio R, Suuronen R, Ponkkonen H, Lindqvist C, Laine P.
Have the causes of maxillofacial fractures changed over the
last 16 years in Finland? An epidemiological study of 725
fractures. Dent Traumatol 2005; 21(1): 14-9.
Allen MJ, Barens MR, Bodiawala GG. The effect of seat belt
legislation on injuries sustained by car occupants. Injury
; 16(7): 471-6.
Gorgu M, Adanali G, Tuneel A, Senen D, Erdogan B.
Airbags and wearing seat belts prevent crush injuries or
reduce severity of injury in low-speed traffic accidents. Eur J
Plast Surg 2002; 25: 215-18.
Lamphier J, Ziccardi V, Ruvo A, Janel M. Complications of
mandibular fractures in urban teaching center. J Oral
Maxillofac Surg 2003; 61(7): 745-9.
Obsorn TE, Bays RA. Pathophysiology and management of
gunshot wounds to the face. In: Foscla RJ, Walker PV. Oral
and maxillofacial trauma. Philadelphia: WB Saunders 1991;
-721.
Ambreen A, Shah R. Causes of maxillofacial injuries-a
three years study. J Surg Pak 2001; 6(4):25-7.
Yamaoka M, Furuska K, Fgueshi K. The assessment of
fractures of the mandibular condyle by use of computerized
tomography: incidence of saggital split fracture. Br J Oral
Maxillofac Surg 1994; 32:77-9.
Qudah MA, Al-Khateeb T, Bataineh AB, Rawashdeh MA.
Mandibular fractures in Jordanians: a comparative study
between young and old patients. J Craniomaxillofac Surg
; 33(2): 103-6.
Stacey DH, Doyle JF, Mount DL, Snyder MC, Gutowski KA.
Management of mandible fractures. Plast Reconstr Surg
; 117(3): 48e-60e.
Manson PN. Facial injuries. In: McCarthy JG, editor. Plastic
Surgery. Philadelphia: W.B. Saunders 1990; 867-1141.
Torgersen S, Tornes K. Maxillofacial fractures in a
Norwegian district. Int J Oral Maxillofac Surg 1992; 21(6):
-8.
Hung YC, Montazem A, Costello MA. The correlation
between mandible fractures and loss of consciousness. J Oral
Maxillofac Surg 2004; 62(8): 938-42.
Collins C, Lee J, Pirinjian G. An analysis of 274 mandible
fractures treated with monocortical fixation. J Oral
Maxillofac Surg 2001; 59: Supplement 1.
Chayra GA, Meador LR, Laskin DM. Comparison of
panoramic and standard radiographs in the diagnosis of
mandibular fractures. J Oral Maxillofac Surg 1986; 44(9):
-9.
Green BE Jr. Use of modified head halter for a Barton
bandage. Plast Reconstr Surg 1972; 49(4): 466-7.
Chidyllo SA, Marschall MA. Teeth in the line of a mandible
fracture: Which should be performed first, extraction or
fixation? Plast Reconstr Surg 1992; 90(1): 135-6.
Lazow SK. The mandible fracture: A treatment protocol. J
Craniomaxillofac Trauma 1996; 2(2): 24-30.
Alpert B, Engelstad M, Kushner GM. Invited review: small
versus large plate fixation of mandibular fractures. J
Craniomaxillofac Trauma 1999; 5(3): 33-9.
Schilli W. Mandibular fractures. In: J. Prein (Ed.), Manual of
Internal Fixation of the Craniofacial Skeleton. Vol. 1, 1st Ed.
New York: Springer; 1998. p. 57-92.
Forrest CR. Application of minimal-access techniques in lag
screw fixation of fractures of the anterior mandible. Plast
Reconstr Surg 1999; 104(7): 2127-34.
Zide MF. Open reduction of mandibular condyle fractures.
Indications and technique. Clin Plast Surg 1989; 16(1):69-76.
Haug RH, Assael LA. Outcomes of open versus closed
treatment of mandibular subcondylar fractures. J Oral
Maxillofac Surg 2001; 59(4): 370-5.
Yerit KC, Enislidis G, Schopper C, Turhani D, Wanschitz F,
Wagner A. et al. Fixation of mandibular fractures with
biodegradable plates and screws. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2002; 94(3): 294-300
Passeri LA, Ellis E 3rd, Sinn DP. Complications of nonrigid
fixation of mandibular angle fractures. J Oral Maxillofac
Surg 1993; 51(4): 382-4.
Teenier TJ, Smith BR. Management of complications
associated with mandible fracture treatment. Atlas Oral
Maxillofac Surg Clin North Am 1997; 5(1):181-209.
Lois D, Black E, Atchison K. Complications of mandible
fractures: A comparison between maxillomandibular versus
rigid fixation. J Oral Maxillofac Surg 2001; 59 (Suppl. 1).
Mathog RH. Nonunion of the mandible. Otolaryngol Clin
North Am 1983; 16(3): 533-47.
Mathog RH, Boies LR Jr. Nonunion of the mandible.
Laryngoscope 1976; 86(7): 908-20.
Downloads
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
