Review of 509 mandibular fractures treated at the University Hospital, Alexandria, Egypt

doi:10.1016/j.bjoms.2005.03.014

British Journal of Oral and Maxillofacial Surgery

Volume 44, Issue 2, April 2006, Pages 107-111

https://doi.org/10.1016/j.bjoms.2005.03.014 Get rights and content

Abstract

Mandibular fracture is one of the most common facial skeletal injuries. Although its main causes are road crashes and violence, the relation between these causes varies from one country to another. We made a retrospective study of the medical records and radiographs of 509 patients treated for mandibular fracture at the University of Alexandria Hospital between 1991 and 2000. The data that we collected included age, sex, aetiology, date of injury, anatomical site of the fracture, associated maxillofacial trauma, and treatment. The prevalence of mandibular fractures was higher in male subjects in all age groups, and the male:female ratio was 3.6:1. Most fractures were sustained by men in the age group 21–30 years and girls between 0 and 10 years, and the monthly incidence was constant. Road crashes were the main cause, followed by falls and assaults. Fractures of the angle were the most common (22%) followed by parasymphyseal fractures (21%) and the lowest was in the coronoid region (1%).

Introduction

Mandibular fractures are twice as common as fractures of the bones of the mid-face and comprise most of the injuries treated by an oral and maxillofacial service.1, 2

Most facial fractures in peacetime result from road crashes, particularly in the developing countries where the tradition and enforcement of highway discipline are yet to be established.2, 3, 4 Studies have suggested that crashes are mainly to the result of recklessness and negligence, poor maintenance of vehicles, driving under the influence of alcohol or drugs, and complete disregard of traffic laws.² Although the main causes of mandibular fractures are road crashes and violence, the relation between these causes varies from one country to another.³ Studies in the past decade have shown that assaults are now becoming the commonest cause of maxillofacial injuries in many developed countries, though road crashes remain the most common cause in many developing countries.³ Some of the highest incidences of mandibular fractures have been reported from Greenland, Zimbabwe, and Kenya in which 97%, 82%, and 75%, respectively are from fighting, while road crashes are the most important cause in France, Jordan, and India.⁴ There are, however, few reports on the causes and incidence of maxillofacial fractures in Middle Eastern countries.5, 6, 7

A clearer understanding of the demographic patterns of mandibular fractures will assist providers of health care as they plan the treatment of maxillofacial injuries.² Such epidemiological information can also be used to guide the future funding of public health programmes geared towards prevention of such injuries.⁴

A fractures at other sites are likely to accompany a facial injury, so medical and dental staff in accident and emergency departments should anticipate such injuriesand be encouraged to be more careful in both clinical and radiographic examinations.8, 9

The aim of this study was to examine the current demographic pattern of mandibular fractures by reviewing the records of patients admitted to the University of Alexandria Hospital during the years 1991–2000.

Section snippets

Patients and methods

The records of all patients who were seen with mandibular fractures from 1991 to 2000 were reviewed. Factors considered were age, sex, site of fracture, month of occurrence, cause of fracture, associated injuries, and treatment. The medical records and radiographs of 509 patients who had 755 mandibular fractures were reviewed.

The statistical package for the social sciences (SPSS version 9.0) was used for entry of data and statistical analysis.

Results

There were 400 boys and men (79%), and 109 girls and women (21%) (Table 1). The male:female ratio was 3.6:1. The ages ranged from 2 to 70 years; male patients had a mean (S.D.) age of 22 (14) years and female patients of 17 (13) years (Table 2).

There were more male patients (27%) in the age group 21–30 years and the fewest (2%) in the age group 61+ years. The highest number of female patients (43%) was in the age group 0–10 years and there were none in the 51–60 years group. Collectively, the

Discussion

The causes and incidence of maxillofacial fractures vary with geographic region, socioeconomic status, culture, religion, and era.9, 10 The results of our investigation are largely in agreement with those of previous reports,1, 5, 11, 12 particularly with regard to age and sex. The highest incidence of mandibular fractures in this study was in the age group 0–10 years, and it was in this group that girls predominated. Men were injured were commonly between the ages of 21 and 30 years, which is

References (16)

J.D. Vetter et al.
Facial fractures occurring in a medium-sized metropolitan area: recent trends
Int. J. Oral Maxillofac. Surg.
(1991)
K. Oikarinen et al.
Mandibular fractures in Northern Finland in the 1980s—a 10 year study
Br. J. Oral Maxillofac. Surg.
(1993)
M.R. Telfer et al.
Trends in the aetiology of maxillofacial fractures in the United Kingdom (1977–1987)
Br. J. Oral Maxillofac. Surg.
(1991)
A.B. Bataineh
Etiology and incidence of maxillofacial fractures in the north of Jordan
Oral Surg. Oral Med. Oral Pathol.
(1998)
C. Oji
Jaw fractures in Enugu, Nigeria, 1985–1995
Br. J. Oral Maxillofac. Surg.
(1999)
V.I. Ugboko et al.
Maxillofacial fractures in a semi-urban Nigerian teaching hospital. A review of 442 cases
Int. J. Oral Maxillofac. Surg.
(1998)
M. Adi et al.
An analysis of mandibular fractures in Dundee, Scotland (1977 to 1985)
Br. J. Oral Maxillofac. Surg.
(1990)
N. Tanaka et al.
Aetiology of maxillofacial fracture
Br. J. Oral Maxillofac. Surg.
(1994)

There are more references available in the full text version of this article.

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Review of 509 mandibular fractures treated at the University Hospital, Alexandria, Egypt

Abstract

Introduction

Section snippets

Patients and methods

Results

Discussion

Int. J. Oral Maxillofac. Surg.

Br. J. Oral Maxillofac. Surg.

Br. J. Oral Maxillofac. Surg.

Oral Surg. Oral Med. Oral Pathol.

Br. J. Oral Maxillofac. Surg.

Int. J. Oral Maxillofac. Surg.

Br. J. Oral Maxillofac. Surg.

Br. J. Oral Maxillofac. Surg.