Mandible Fractures

Abstract

Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.

Keywords

mandibular fracture - occlusion - facial trauma - open reduction - maxillomandibular fixation

• References

• 1 Afrooz PN, Bykowski MR, James IB, Daniali LN, Clavijo-Alvarez JA. The epidemiology of mandibular fractures in the United States, part 1: a review of 13,142 cases from the US National Trauma Data Bank. J Oral Maxillofac Surg 2015; 73 (12) 2361-2366
• 2 Erdmann D, Follmar KE, Debruijn M , et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg 2008; 60 (4) 398-403
• 3 Ellis III E, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol 1985; 59 (2) 120-129
• 4 Murphy Jr RX, Birmingham KL, Okunski WJ, Wasser T. The influence of airbag and restraining devices on the patterns of facial trauma in motor vehicle collisions. Plast Reconstr Surg 2000; 105 (2) 516-520
• 5 Hitosugi M, Mizuno K, Nagai T, Tokudome S. Analysis of maxillofacial injuries of vehicle passengers involved in frontal collisions. J Oral Maxillofac Surg 2011; 69 (4) 1146-1151
• 6 Hyman DA, Saha S, Nayar HS, Doyle JF, Agarwal SK, Chaiet SR. Patterns of facial fractures and protective device use in motor vehicle collisions from 2007 to 2012. JAMA Facial Plast Surg 2016; 18 (6) 455-461
• 7 Lamphier J, Ziccardi V, Ruvo A, Janel M. Complications of mandibular fractures in an urban teaching center. J Oral Maxillofac Surg 2003; 61 (7) 745-749 , discussion 749–750
• 8 Olson RA, Fonseca RJ, Zeitler DL, Osbon DB. Fractures of the mandible: a review of 580 cases. J Oral Maxillofac Surg 1982; 40 (1) 23-28
• 9 Beirne JC, Butler PE, Brady FA. Cervical spine injuries in patients with facial fractures: a 1-year prospective study. Int J Oral Maxillofac Surg 1995; 24 (1 Pt 1): 26-29
• 10 Sinclair D, Schwartz M, Gruss J, McLellan B. A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries. J Emerg Med 1988; 6 (2) 109-112
• 11 Haug RH, Wible RT, Likavec MJ, Conforti PJ. Cervical spine fractures and maxillofacial trauma. J Oral Maxillofac Surg 1991; 49 (7) 725-729
• 12 Luce EA, Tubb TD, Moore AM. Review of 1,000 major facial fractures and associated injuries. Plast Reconstr Surg 1979; 63 (1) 26-30
• 13 Baker AB, Mackenzie W. Facial and cervical injuries. Med J Aust 1976; 1 (8) 236-237
• 14 Mulligan RP, Friedman JA, Mahabir RC. A nationwide review of the associations among cervical spine injuries, head injuries, and facial fractures. J Trauma 2010; 68 (3) 587-592
• 15 Stacey DH, Doyle JF, Gutowski KA. Safety device use affects the incidence patterns of facial trauma in motor vehicle collisions: an analysis of the National Trauma Database from 2000 to 2004. Plast Reconstr Surg 2008; 121 (6) 2057-2064
• 16 Elahi MM, Brar MS, Ahmed N, Howley DB, Nishtar S, Mahoney JL. Cervical spine injury in association with craniomaxillofacial fractures. Plast Reconstr Surg 2008; 121 (1) 201-208
• 17 Mithani SK, St-Hilaire H, Brooke BS, Smith IM, Bluebond-Langner R, Rodriguez ED. Predictable patterns of intracranial and cervical spine injury in craniomaxillofacial trauma: analysis of 4786 patients. Plast Reconstr Surg 2009; 123 (4) 1293-1301
• 18 AO Foundation. AO Surgery reference. Available at: https://www2.aofoundation.org/ . Accessed December 20, 2016
• 19 Shetty V, Freymiller E. Teeth in the line of fracture: a review. J Oral Maxillofac Surg 1989; 47 (12) 1303-1306
• 20 Baykul T, Erdem E, Dolanmaz D, Alkan A. Impacted tooth in mandibular fracture line: treatment with closed reduction. J Oral Maxillofac Surg 2004; 62 (3) 289-291
• 21 Tay AB, Lai JB, Lye KW , et al. Inferior alveolar nerve injury in trauma-induced mandible fractures. J Oral Maxillofac Surg 2015; 73 (7) 1328-1340
• 22 Wilson IF, Lokeh A, Benjamin CI , et al. Prospective comparison of panoramic tomography (zonography) and helical computed tomography in the diagnosis and operative management of mandibular fractures. Plast Reconstr Surg 2001; 107 (6) 1369-1375
• 23 Roth FS, Kokoska MS, Awwad EE , et al. The identification of mandible fractures by helical computed tomography and Panorex tomography. J Craniofac Surg 2005; 16 (3) 394-399
• 24 Ellis III E, Miles BA. Fractures of the mandible: a technical perspective. Plast Reconstr Surg 2007; 120 (7) (Suppl. 02) 76S-89S
• 25 Nishioka GJ, Van Sickels JE. Transoral plating of mandibular angle fractures: a technique. Oral Surg Oral Med Oral Pathol 1988; 66 (5) 531-535
• 26 Ellis III E. A study of 2 bone plating methods for fractures of the mandibular symphysis/body. J Oral Maxillofac Surg 2011; 69 (7) 1978-1987
• 27 Agnihotri A, Prabhu S, Thomas S. A comparative analysis of the efficacy of cortical screws as lag screws and miniplates for internal fixation of mandibular symphyseal region fractures: a randomized prospective study. Int J Oral Maxillofac Surg 2014; 43 (1) 22-28
• 28 Gutta R, Tracy K, Johnson C, James LE, Krishnan DG, Marciani RD. Outcomes of mandible fracture treatment at an academic tertiary hospital: a 5-year analysis. J Oral Maxillofac Surg 2014; 72 (3) 550-558
• 29 Schubert W, Kobienia BJ, Pollock RA. Cross-sectional area of the mandible. J Oral Maxillofac Surg 1997; 55 (7) 689-692 , discussion 693
• 30 Dodson TB. Third molars may double the risk of an angle fracture of the mandible. Evid Based Dent 2004; 5 (3) 78 . Doi: 10.1038/sj.ebd.6400263
• 31 James RB, Fredrickson C, Kent JN. Prospective study of mandibular fractures. J Oral Surg 1981; 39 (4) 275-281
• 32 Ellis III E. A prospective study of 3 treatment methods for isolated fractures of the mandibular angle. J Oral Maxillofac Surg 2010; 68 (11) 2743-2754
• 33 Chuong R, Donoff RB, Guralnick WC. A retrospective analysis of 327 mandibular fractures. J Oral Maxillofac Surg 1983; 41 (5) 305-309
• 34 Ellis III E. Management of fractures through the angle of the mandible. Oral Maxillofac Surg Clin North Am 2009; 21 (2) 163-174
• 35 Tate GS, Ellis III E, Throckmorton G. Bite forces in patients treated for mandibular angle fractures: implications for fixation recommendations. J Oral Maxillofac Surg 1994; 52 (7) 734-736
• 36 Champy M, Lodde JP. [Osteosynthesis of the external orbital cavity using screwed plates. Therapeutic indications and results]. Rev Otoneuroophtalmol 1976; 48 (4) 243-248
• 37 Al-Moraissi EA, Ellis III E. What method for management of unilateral mandibular angle fractures has the lowest rate of postoperative complications? A systematic review and meta-analysis. J Oral Maxillofac Surg 2014; 72 (11) 2197-2211
• 38 Cillo Jr JE, Ellis III E. Management of bilateral mandibular angle fractures with combined rigid and nonrigid fixation. J Oral Maxillofac Surg 2014; 72 (1) 106-111
• 39 Booth PW, Schendel SA, Hausamen II JE. Maxillofacial surgery. 1. Philadelphia, PA: Churchill Livingstone Elsevier; 2007
• 40 Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg 2006; 34 (7) 421-432
• 41 Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 1983; 41 (2) 89-98
• 42 Ellis III E. Discussion: which factors are associated with open reduction of adult mandibular condylar injuries?. Plast Reconstr Surg 2016; 137 (6) 1822-1823
• 43 Marker P, Nielsen A, Bastian HL. Fractures of the mandibular condyle. Part 1: patterns of distribution of types and causes of fractures in 348 patients. Br J Oral Maxillofac Surg 2000; 38 (5) 417-421
• 44 Santler G, Kärcher H, Ruda C, Köle E. Fractures of the condylar process: surgical versus nonsurgical treatment. J Oral Maxillofac Surg 1999; 57 (4) 392-397 , discussion 397–398
• 45 Kyzas PA, Saeed A, Tabbenor O. The treatment of mandibular condyle fractures: a meta-analysis. J Craniomaxillofac Surg 2012; 40 (8) e438-e452
• 46 Haug RH, Assael LA. Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg 2001; 59 (4) 370-375 , discussion 375–376
• 47 Walker RV. Condylar fractures: nonsurgical management. J Oral Maxillofac Surg 1994; 52 (11) 1185-1188
• 48 Ellis III E, Simon P, Throckmorton GS. Occlusal results after open or closed treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 2000; 58 (3) 260-268
• 49 Ellis III E, Throckmorton G. Facial symmetry after closed and open treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 2000; 58 (7) 719-728 , discussion 729–730
• 50 Schneider M, Erasmus F, Gerlach KL , et al. Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: a randomized, prospective, multicenter study with special evaluation of fracture level. J Oral Maxillofac Surg 2008; 66 (12) 2537-2544
• 51 Al-Moraissi EA, Ellis III E. Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: a systematic review and meta-analysis. J Oral Maxillofac Surg 2015; 73 (3) 482-493
• 52 Suzuki T, Kawamura H, Kasahara T, Nagasaka H. Resorbable poly-L-lactide plates and screws for the treatment of mandibular condylar process fractures: a clinical and radiologic follow-up study. J Oral Maxillofac Surg 2004; 62 (8) 919-924
• 53 Singh V, Bhagol A, Goel M, Kumar I, Verma A. Outcomes of open versus closed treatment of mandibular subcondylar fractures: a prospective randomized study. J Oral Maxillofac Surg 2010; 68 (6) 1304-1309
• 54 Gupta M, Iyer N, Das D, Nagaraj J. Analysis of different treatment protocols for fractures of condylar process of mandible. J Oral Maxillofac Surg 2012; 70 (1) 83-91
• 55 Marker P, Nielsen A, Bastian HL. Fractures of the mandibular condyle. Part 2: results of treatment of 348 patients. Br J Oral Maxillofac Surg 2000; 38 (5) 422-426
• 56 Forouzanfar T, Lobbezoo F, Overgaauw M , et al. Long-term results and complications after treatment of bilateral fractures of the mandibular condyle. Br J Oral Maxillofac Surg 2013; 51 (7) 634-638
• 57 Ellis III E, Kellman RM, Vural E. Subcondylar fractures. Facial Plast Surg Clin North Am 2012; 20 (3) 365-382
• 58 Ellis III E, Price C. Treatment protocol for fractures of the atrophic mandible. J Oral Maxillofac Surg 2008; 66 (3) 421-435
• 59 Bradley JC. Age changes in the vascular supply of the mandible. Br Dent J 1972; 132 (4) 142-144
• 60 Bruce RA, Strachan DS. Fractures of the edentulous mandible: the Chalmer J. Lyons Academy study. J Oral Surg 1976; 34 (11) 973-979
• 61 Bruce RA, Ellis III E. The second Chalmers J. Lyons Academy study of fractures of the edentulous mandible. J Oral Maxillofac Surg 1993; 51 (8) 904-911
• 62 Buchbinder D. Treatment of fractures of the edentulous mandible, 1943 to 1993: a review of the literature. J Oral Maxillofac Surg 1993; 51 (11) 1174-1180
• 63 Luhr HG, Reidick T, Merten HA. Results of treatment of fractures of the atrophic edentulous mandible by compression plating: a retrospective evaluation of 84 consecutive cases. J Oral Maxillofac Surg 1996; 54 (3) 250-254 , discussion 254–255
• 64 Eyrich GK, Grätz KW, Sailer HF. Surgical treatment of fractures of the edentulous mandible. J Oral Maxillofac Surg 1997; 55 (10) 1081-1087 , discussion 1087–1088
• 65 Iatrou I, Samaras C, Theologie-Lygidakis N. Miniplate osteosynthesis for fractures of the edentulous mandible: a clinical study 1989-96. J Craniomaxillofac Surg 1998; 26 (6) 400-404
• 66 Kunz C, Hammer B, Prein J. [Fractures of the edentulous atrophic mandible. Fracture management and complications]. . [in German] Mund Kiefer Gesichtschir 2001; 5 (4) 227-232
• 67 Allard RH, Lekkas C. Unusual healing of a fracture of an atrophic mandible. Report of a case. Oral Surg Oral Med Oral Pathol 1983; 55 (6) 560-563
• 68 Zachariades N, Papavassiliou D, Triantafyllou D , et al. Fractures of the facial skeleton in the edentulous patient. J Maxillofac Surg 1984; 12 (6) 262-266
• 69 Rowe NL. Fractures of the jaws in children. J Oral Surg 1969; 27 (7) 497-507
• 70 Kaban LB, Mulliken JB, Murray JE. Facial fractures in children: an analysis of 122 fractures in 109 patients. Plast Reconstr Surg 1977; 59 (1) 15-20
• 71 Sherick DG, Buchman SR, Patel PP. Pediatric facial fractures: a demographic analysis outside an urban environment. Ann Plast Surg 1997; 38 (6) 578-584 , discussion 584–585
• 72 Smith DM, Bykowski MR, Cray JJ , et al. 215 mandible fractures in 120 children: demographics, treatment, outcomes, and early growth data. Plast Reconstr Surg 2013; 131 (6) 1348-1358
• 73 Owusu JA, Bellile E, Moyer JS, Sidman JD. Patterns of pediatric mandible fractures in the United States. JAMA Facial Plast Surg 2016; 18 (1) 37-41
• 74 Kaban LB. Diagnosis and treatment of fractures of the facial bones in children 1943-1993. J Oral Maxillofac Surg 1993; 51 (7) 722-729
• 75 Siy RW, Brown RH, Koshy JC, Stal S, Hollier Jr LH. General management considerations in pediatric facial fractures. J Craniofac Surg 2011; 22 (4) 1190-1195
• 76 James DR. Maxillofacial injuries in children. Rowe NL, Williams JL. Maxillofacial Injuries. New York: Churchill Livingstone; 1985: 538-558
• 77 Wolfswinkel EM, Weathers WM, Wirthlin JO, Monson LA, Hollier Jr LH, Khechoyan DY. Management of pediatric mandible fractures. Otolaryngol Clin North Am 2013; 46 (5) 791-806
• 78 MacLennan WD. Consideration of 180 cases of typical fractures of the mandibular condylar process. Br J Plast Surg 1952; 5 (2) 122-128
• 79 Ferreira PC, Amarante JM, Silva PN , et al. Retrospective study of 1251 maxillofacial fractures in children and adolescents. Plast Reconstr Surg 2005; 115 (6) 1500-1508
• 80 Demianczuk AN, Verchere C, Phillips JH. The effect on facial growth of pediatric mandibular fractures. J Craniofac Surg 1999; 10 (4) 323-328
• 81 Schweinfurth JM, Koltai PJ. Pediatric mandibular fractures. Facial Plast Surg 1998; 14 (1) 31-44
• 82 Lund K. Mandibular growth and remodelling processes after condylar fracture. A longitudinal roentgencephalometric study. Acta Odontol Scand Suppl 1974; 32 (64) 3-117
• 83 Ghasemzadeh A, Mundinger GS, Swanson EW, Utria AF, Dorafshar AH. Treatment of pediatric condylar fractures: a 20-year experience. Plast Reconstr Surg 2015; 136 (6) 1279-1288
• 84 Rémi M, Christine MC, Gael P, Soizick P, Joseph-André J. Mandibular fractures in children: long term results. Int J Pediatr Otorhinolaryngol 2003; 67 (1) 25-30
• 85 Naran S, Keating J, Natali M , et al. The safe and efficacious use of arch bars in patients during primary and mixed dentition: a challenge to conventional teaching. Plast Reconstr Surg 2014; 133 (2) 364-366
• 86 Iizuka T, Lindqvist C. Rigid internal fixation of fractures in the angular region of the mandible: an analysis of factors contributing to different complications. Plast Reconstr Surg 1993; 91 (2) 265-271 , discussion 272–273
• 87 Anderson T, Alpert B. Experience with rigid fixation of mandibular fractures and immediate function. J Oral Maxillofac Surg 1992; 50 (6) 555-560 , discussion 560–561
• 88 Iizuka T, Lindqvist C, Hallikainen D, Paukku P. Infection after rigid internal fixation of mandibular fractures: a clinical and radiologic study. J Oral Maxillofac Surg 1991; 49 (6) 585-593
• 89 Odom EB, Snyder-Warwick AK. Mandible fracture complications and infection: the influence of demographics and modifiable factors. Plast Reconstr Surg 2016; 138 (2) 282e-289e
• 90 Haug RH, Schwimmer A. Fibrous union of the mandible: a review of 27 patients. J Oral Maxillofac Surg 1994; 52 (8) 832-839
• 91 Mathog RH, Toma V, Clayman L, Wolf S. Nonunion of the mandible: an analysis of contributing factors. J Oral Maxillofac Surg 2000; 58 (7) 746-752 , discussion 752–753