|Year : 2017 | Volume
| Issue : 4 | Page : 295-299
A Two-Year Prospective Analysis of Mandibular Fractures in Western Population of Maharashtra, India
Ashwinirani Suragimath1, Girish Suragimath2, Mounesh Kumar3
1 Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
2 Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
3 Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
|Date of Submission||23-May-2017|
|Date of Acceptance||24-Jan-2018|
|Date of Web Publication||15-Feb-2018|
Dr. Ashwinirani Suragimath
Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad - 415 110, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Trauma to the facial region causes injuries to hard and soft tissues of the face. Injuries to the maxillofacial region are increasing in frequency and severity because of the increased number of road traffic accidents (RTAs) and increased number of violence. The purpose of this study was to evaluate age, gender distribution, etiology, and pattern of mandibular fractures in Western part of Maharashtra population. Materials and Methods: The study was conducted in the Department of Oral Medicine and Radiology for a period of two years from June 2013 to June 2015. Clinical examination of all trauma patients was done and diagnosis was made based on signs, clinical features, and confirmed by orthopantomographs. Results: Totally, 193 patients were detected with different types of mandibular fractures. Study group involved 77.2% males and 22.8% females with a male to female ratio of 3.3:1. Majority of patients were in the age group of 21–30 years followed by 31–40 years. Trauma due to RTAs were more common followed by assaults and fall. Parasymphyseal fractures were most common type followed by condylar fracture and fracture of angle of mandible. Conclusion: Males were most commonly affected by trauma than females with a predominant age group of 21–30 years. Majority of trauma were due to RTAs with parasymphyseal as most common type of fracture.
Keywords: Condyle, mandible, maxillofacial trauma, parasymphyseal
|How to cite this article:|
Suragimath A, Suragimath G, Kumar M. A Two-Year Prospective Analysis of Mandibular Fractures in Western Population of Maharashtra, India. J Indian Acad Oral Med Radiol 2017;29:295-9
|How to cite this URL:|
Suragimath A, Suragimath G, Kumar M. A Two-Year Prospective Analysis of Mandibular Fractures in Western Population of Maharashtra, India. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2019 May 22];29:295-9. Available from: http://www.jiaomr.in/text.asp?2017/29/4/295/225557
| Introduction|| |
Maxillofacial (MF) regions include maxillary, mandibular, nasal, orbital, zygomatic, and ethmoid bones. Maxillary region consists of bony components of the hard palate and alveolar process, while the mandibular region consists of mandible and the temporomandibular joint. Trauma is a type of injury where external force is being applied suddenly and violently at the body which causes a serious injury. MF trauma is often associated with morbidity, physical, functional, and esthetic damage.
The incidence and epidemiological causes of MF trauma and facial fractures vary widely in different regions of the world due to social, economical, cultural consequences, awareness of traffic regulations, and alcohol consumption. Injuries to the MF region are increasing in frequency and severity because of increased number of vehicles with increased number of road traffic accidents (RTAs), improper roads in developing countries, and increasing socioeconomic activities of the population.
Studies in developed countries showed assault as the leading cause of facial fractures followed mostly by motor vehicle accidents, pedestrian collisions, stumbling, sports and industrial accidents, but in underdeveloped or developing areas of the world, the leading cause was RTAs followed by assaults and other reasons.,,,,,, The present study was designed to analyze the age, gender distribution, etiology, and patterns of mandibular fractures using orthopantomogram (OPG) in western part of Maharashtra population.
| Materials and Methods|| |
The study was carried out in the Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Maharashtra, India. Ethical clearance was obtained before commencing the study. Patients reporting to the department with a chief complaint of trauma were included in the study for a period of two years from June 2013 to June 2015. The study participants were explained about the objectives of the study and an informed consent was obtained before enrolling them in the study.
Clinical examination was done using mouth mirror and probe. Patients with mandibular fractures were included in the study. The diagnosis of a fracture was based on the history, signs and symptoms, visual finding, manual examination, and OPG radiographs. Exact determination of site and pattern of bony injury was determined by correlating it radiographically using OPG. All OPGs were captured using Xtropan 2000 system (Xtronics Imaging Systems, Mumbai, India, tube potential: 50–85 kV, tube current: 12 mA, and time: 14 s) using Carestream (T-Mat GIRA) films. The magnification factor reported by the manufacturer was 1.2.
In our study, the mandible was divided into condylar, coronoid, angle, body, symphyseal, parasymphyseal, ramus, and dentoalveolar regions. The etiological factors were classified as RTAs, fall from height, assaults, sport injuries, and miscellaneous. Soft tissue lacerations were not recorded. Age, gender, etiology, and pattern of mandibular fractures were recorded in clinical proforma. The data recorded were entered in MS Excel sheet and subjected to statistical analysis using the Statistical Package for the Social Sciences IBM SPSS Statistics for windows. Version 20.0. (Armonk, NY: IBM Corp.).
| Results|| |
Gender-wise distribution of patients
A total of 193 patients with mandibular fractures were recorded. Out of 193 patients, 149 (77.2%) were males and 44 (22.8%) were females. Males sustained significantly more injuries as compared to females, with an overall ratio of 3.3:1 [Table 1].
Age-wise distribution of fractures
Majority of fractures were seen in the age group of 21–30 (35.2%) years followed by 31–40 years (30.5%) of life, constituting a major proportion (65.7%). In patients aged above 61, there was less incidence of fractures that accounts for only 4.1% [Table 2].
Site-wise distribution of fractures
Among 193 total fractures, 96 fractures were present on right side and 84 fractures were present on left side [Table 3].
Gender-wise distribution of different types of mandibular fractures
Mandibular fractures occurred most commonly in the parasymphyseal region, about 61 cases (31.6%), followed by condylar region about 47 cases (24.3%). The third most common site for fracture was angle, about 25 cases (12.9%), followed by body, accounting for 22 cases (11.3%), dentoalveolar, and symphysis fractures. The least common fractures reported were coronoid fractures (2%) and ramus fractures (1.5%) [Table 4] and [Figure 1][Figure 2][Figure 3][Figure 4][Figure 5][Figure 6].
|Figure 1: Diffuse swelling on right middle and lower third of face with reduced mouth opening. OPG showing right angle left parasymphyseal and condylar fracture|
Click here to view
|Figure 2: OPG showing right condylar fracture with bilateral body fractures|
Click here to view
|Figure 5: OPG showing fractures of right angle and left body of mandible|
Click here to view
|Figure 6: OPG showing bilateral coronoid fractures with right body and angle fractures|
Click here to view
|Table 4: Gender-wise distribution of different types of mandibular fractures|
Click here to view
Etiology for mandibular fractures
Fractures due to RTAs were most common (62.6%), followed by assaults 16%, falls 13.9%, sport injuries and miscellaneous fractures constituted for low rates [Table 5].
| Discussion|| |
Trauma is the leading cause of deaths that occurred in the first 40 years of life. In polytrauma victims, MF injuries are frequently seen. RTAs are most common causes of trauma due to rapid increase in the number of vehicles. The country has world's highest fatality rate in RTAs, 20 times that of developed countries. In India, eight people get killed for every 100 vehicles, whereas in developed countries such as UK, USA, and France, one person gets killed for every 1,000 vehicles.
Incidence and etiology of MF traumas have been carried out in countries such as Austria, Germany, New Zealand, and United Arab Emirates. Few studies from India were also found in literature., Most of the studies considered entire fractures in MF region, but in our study we had considered only mandibular fractures because OPGs show mandibular fractures more clearly than mid-facial fractures.
Mandible being the most prominent bone in face is often fractured more than the strongly supported middle-third of the face. Various studies conducted previously by Veeresha and Shankararadhya, Motamedi, Ortakoglu et al., and Lone et al. have also found mandibular fractures more common than maxillary fractures.
The mandibular fractures were higher in males than in females with a ratio of 3.3:1 in our study, which was consistent with previous literature., Males are at greater risk due to their greater participation in activities such as driving vehicles, sports that involve physical contact, an active social life, and use of drugs such as alcohol. In Middle East countries, male to female ratios varies from 4.5:1 to 11:1., This greater proportion variation may be due to segregation of women from social life in these countries. Due to change in women's social behavior, increased percentage of working population either for office activities or day-to-day home activities such as for vegetable or groceries shopping, and for leaving their kids for school and tuitions, females showed increased prevalence of trauma than males.
Majority of mandibular fractures in our study occurred in the age group of 21–30 years (35.2%), followed by 31–40 years (30.5%) and 11–20 years (11.3%). The results were in accordance with the previous studies., The high incidence of fractures in second and third decades of life might be due to the facts that people belonging to this decade are more active, majority are college-going students who are learners of vehicle driving, careless driving on roads, energetic, take active participation in dangerous exercises and sports activities, and mostly involved in violence. Patients aged above 60 years had less fractures because this age group is less involved in outdoor activities, which was in accordance with a previous study.
RTAs were the main cause of fractures in our study, which accounted for 62.6% followed by assaults 16% and falls 13.9%, which was in accordance with other Indian and international studies.,, The increasing number of RTAs in developing countries such as India is due to conditions of roads, inadequate road safety awareness, increased number of two wheelers, non-usage of seat belts or helmets, breaking of highway rules, use of mobile phones while driving, and use of alcohol and driving. Assaults have been reported as the main cause of MF injuries in countries such as United States, Finland, and Switzerland. In the present study, assaults were the second most prevalent etiological factor (16%).
In the present study, parasymphyseal fracture was most common type followed by condylar, angle, and body. Accidents from vehicles resulted in greater number of parasymphysis and condylar fractures as traffic accident victims commonly suffer posteriorly directed force to mandible as a result of fall. The results of our study with site distribution were consistent with other studies.,
| Conclusion|| |
Majority of mandibular fractures were in parasympyseal and condylar region due to RTAs with higher frequency in males. Mandatory use of helmet and seat belts may reduce the RTAs.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Anderson T, Heitger M, Macleod AD. Concussion and mild head injury. Pract Neurol 2006;6:342-57.
Chandra Shekar BR, Reddy C. A five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated at two hospitals of Mysore city. Indian J Dent Res 2008;19:304-8.
Lee JH, Cho BK, Park WJ. A 4-year retrospective study of facial fractures on Jeju, Korea. J Craniomaxillofac Surg 2010;38:192-6.
Gassner R, Tuli T, Hächl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: A 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg 2003;31:51-61.
van den Bergh B, Karagozoglu KH, Heymans MW, Forouzanfar T. Aetiology and incidence of maxillofacial trauma in Amsterdam: A retrospective analysis of 579 patients. J Craniomaxillofac Surg 2012;40:165-9.
Bakardjiev A, Pechalova P. Maxillofacial fractures in Southern Bulgaria – A retrospective study of 1706 cases. J Craniomaxillofac Surg 2007;35:147-50.
Iida S, Kogo M, Sugiura T, Mima T, Matsuya T. Retrospective analysis of 1502 patients with facial fractures. Int J Oral Maxillofac Surg 2001;30:286-90.
Ramli R, Rahman NA, Rahman RA, Hussaini HM, Hamid AL. A retrospective study of oral and maxillofacial injuries in Seremban Hospital, Malaysia. Dent Traumatol 2011;27:122-6.
Motamedi MH: An assessment of maxillofacial fractures: A 5-year study of 237 patients. J Oral Maxillofac Surg 2003;61:61-4.
Park K. Epidemiology of chronic non-communicable diseases. Textbook of Preventive and Social Medicine. 17th
ed. Jabalpur: Banarsidas Bhanot Publishers; 2005. p. 303-7.
Gassner R, Tuli T, Hachl O, Morelra R, Ulmer H. Craniomaxillofacial trauma in children: A review of 3,385 cases with 6,060 injuries in 10 years. J Oral Maxillofac Surg 2004;62:399-407.
Iida S, Hassfeld S, Reuther T, Schwelgert HG, Haag C, Klein J, et al
. Maxillofacial fractures resulting from falls. J Craniomaxillofac Surg 2003;31:278-83.
Lee KH, Snape L, Steenberg LJ, Worthington J. Comparison between interpersonal violence and motor vehicle accidents in the aetiology of maxillofacial fractures. ANZ J Surg 2007;77:695-8.
Klenk G, Kovacs A. Etiology and patterns of facial fractures in the United Arab Emirates. J Craniofac Surg 2003;14:78-84.
Subashraj K, Nandakumar N, Ravindran C. Review of maxillofacial injuries in Chennai, India: A study of 2748 cases. Br J Oral Maxillofac Surg 2007;45:637-9.
Veeresha KL, Shankararadhya MR. Analysis of fractured mandible and fractured middle third of the face in road traffic accidents. J Indian Dent Assoc 1987;59:150-3.
Ortakoǧlu K, Gunaydin Y, Aydintuǧ YS, Bayar GR. An analysis of maxillofacial fractures: A 5-year survey of 157 patients. Mil Med 2004;169:723-7.
Lone P, Singh AP, Kour I, Kumar M. A 2-year retrospective analysis of facial injuries in patients treated at department of oral and maxillofacial surgery, IGGDC, Jammu, India. Natl J Maxillofac Surg 2014;5:149-52.
] [Full text]
Bali R, Sharma P, Garg A, Dhillon G. A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India. J Inj Violence Res 2013;5:108-16.
Mohajerani SH, Asghari S. Pattern of mid-facial fractures in Tehran, Iran. Dent Traumatol 2011;27:131-4.
Adebayo ET, Ajike OS, Adekeye EO. Analysis of the pattern of maxillofacial fractures in Kaduna, Nigeria. Br J Oral Maxillofac Surg 2003;41:396-400.
Al-Khateeb T, Abdullah FM. Craniomaxillofacial injuries in the United Arab Emirates: A retrospective study. J Oral Maxillofac Surg 2007;65:1094-101.
Kadkhodaie MH. Three-year review of facial fractures at a teaching hospital in northern Iran. Br J Oral Maxillofac Surg 2006;44:229-31.
Schaftenaar E, Bastiaens GJ, Simon EN, Merkx MA. Presentation and management of maxillofacial trauma in Dar es Salaam, Tanzania. East Afr Med J 2009;86:254-8.
Ansari MH. Maxillofacial fractures in Hamedan province, Iran: A retrospective study (1987-2001). J Craniomaxillofac Surg 2004;32:28-34.
Eggensperger N, Smolka K, Scheidegger B, Zimmermann H, Iizuka T. A 3-year survey of assault-related maxillofacial fractures in central Switzerland. J Craniomaxillofac Surg 2007;35:161-7.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]