MANAGEMENT PROTOCOL OF MANDIBULAR FRACTURES AT PAKISTAN INSTITUTE OF MEDICAL SCIENCES, ISLAMABAD, PAKISTAN.

Authors

  • Samira Ajmal
  • Muhammad Ayub Khan
  • Huma Jadoon
  • Saleem A. Malik

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 basictherapeutic principles of reduction and stabilization, a variety of currently accepted treatmentmodalities indicate a lack of consensus. The authors evaluate the incidence, etiology, managementand complications of 344 mandibular fractures in 228 patients treated in the Department of Plasticand Reconstructive Surgery at Pakistan Institute of Medical Sciences (PIMS), Islamabad,Pakistan, during a three year period. Indications and techniques for closed and open treatment ofmandibular fractures are reviewed along with any complications of these fractures or theirmanagement. Methods: A total of 344 mandibular fractures in 228 patients were included in thisstudy. The sex, age, etiology, presentation, fracture characteristics, associated injuries, variousmethods 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 andscrew fixation systems have proved to provide the best rigid stabilization, early mobility andassociated with least complications. There was a satisfactory bone healing in all the patients and aminimal complication rate associated with open reduction and internal fixation (ORIF).Conclusion: Mandibular fractures occur with high frequency in road traffic accidents andinterpersonal violence. They are among the most common types of facial fractures treated by theplastic surgeons. They must be managed carefully to maintain the function of the mandible, reestablish proper occlusion, and minimize secondary complications. Open reduction and internalfixation 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.

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