Taiwan J Oral Maxillofac Surg
22: 175-188, September 2011
Two-Year Treatment Outcomes of Mandibular
Fractures in a Suburban Hospital of Taiwan
Chih-Wen Cheng', Rong-Wu Yong', Che-Yi Lin', Min-Te Chang
2
,
Chun-Jung Chen', Wei-Fan Chiang
L3
1 Department of Dentis甘γ, Chi-Mei Medical Center, Liouying, Tain凹, Taiwan
2 Department of Dentist門,Chi-MeiMedical Center, Yongkang, Tainan, Taiwan
1 School of Dentis甘y, National Yang-Ming Universi旬, Taip凹, Taiwan
Abstract
台灣口外誌
Purpose: The etiology, type, and surgical outcomes of mandibular
tractures in Taiwan have rarely been described. A study of the current仕ends
in mandibular fractures at a suburban hospital would help clinicians and
public health researchers better understand the differences between urban and
suburban mandibular tractures and to design appropriate treatment strategies
Patients and Methods: This retrospective study analyzed 67 patients with
mandibular tractures between 2009 and 2010 at the Department of Oral and
Maxillofacial Surgery, Chi-Mei Hospital, Liouying. Under the supervision of a
single surgeon (Chiang), 102 tractured subsites were甘eated.Results: The maleto-female ratio was 1.4:1. Motorcycle accidents were the most common cause
of mandibular企actures(72%). Symphysis was the major subsite of fractures
(41 %), followed by body fractures (n=16, 15.7%) and angle fractures (n=呵,
14.7%). In this study, 68.7% of the patients displayed combined fractu時,which
was defined as multiple mandibular subsites 01-midface fracture. ln this study,
67 (66%) tractured sites among 55 patients were甘eatedby surgical reduction
and bone plate fixation, including 21 sites treated by the 1.6-mm miniplate
system, 36 sites treated by the 2.0-mm bone plate system, 9 sites treated by the
2.3-mm reconstruction plate system and one site by the lag screw technique
I叮叮ySeverity Score, comminuted/splitting fracture, and combined midfacial
bone fracture displayed a significant association with a prolonged postoperative
stay. Iatrogenic complications, such as postoperative aseptic abscesses and
screw loosening, appeared in 3 (4.5%) 臼ses_ Conclusion: Motorcycle accident
is a major etiology of mandibuJar fracture in the subw-b and usually results in
a more severe Injury Severity Score. The optimal duration of the hospital stay
must be evaluated while taking into consideration the associated injuries and
the type of fracture. The osteosynthesis of mandibular fractures involving the
use of 1.6-mm miniplates, 2.0-mml2.3-mm nonlocking bone plates yielded ideal
outcomes
Key words: MandibuJar tracture, Suburb, Motorcycle, Prolonged postoperative
stay, Complications.
175
Taiwan J Oral Maxillofac Surg
Introduction
台灣口外誌
Liouying,什omFebruary 2009 to December 2010
were retrospectively analyzed. Pathological and
The management of mandibular fracturc is infected fraclures were excluded. There were two
a common practice for Oral and Maxillofacial major strategies for treating mandibular fractures
Surgeons. Mandibular fi'acture can occur because The patients who had high-positioned subcondylar
of various causes, such as traffic acciclenls, "8I1s, 什actureand condylar fractures were reduced with
assaults, and sports, and can occur in isolalion three-and one-week rigid intermaxillary自xatlon
or in combination with other injuries. The (lMr), respectively (Figure 1). Rubber traction
epidemiology of these fractures varies depencling (elastic IMF) was applied lo these palients fOI
on the geographic area, socioeconomic status one to two more weeks thereafter. Another
of the individual involved, and the period of group of patients with symphys時, body and lowinvestigation 1';. In Western society, the 1970s positioned subcondylar fractures Were treated
involved a documented shift in the mechanism by open reduction and internal fixation by bone
ï 12
of injury leading to mandibular fractures' '" plates. After the surgery, patients postoperatively
Specifically, vi ol巴nce and sporting injllries underwent elastic IMF for one to two more
replaced motor vehicl巴 accidents as the major weeks (Figure 2 & 3). If the patients displayed
cause of mandibular 仕acture. These trends seem combined midfacial fractures, boltom-llp fixation
to hold true for the urban distinct in particular, followed the sequence of lower dental arch
whereas rural communities still show a significant reconstruction, mandibular fixation, rigid IMF,
number of fractures incurred during automobile and midfacial fìxation. The surgical reduction and
accidents
8
'
17
In the 1980s, a study of mandibular fixation of mandibular 什actures was performed as
佇actures in the urban distinct of Taiwan showed soon as possible if the patient presented stable
that traffic accidents were still the major callse". vital signs and clear consciousness. The surgical
Different causes of mandibular fracture may be intervention was performed in the following
associated with age and gender, or the site and sequence: the 什acturecl segments were reduced
severity ofthe injury. by the Erich arch bal', any loose teeth were
Data available on the etiology and pattern removed, and bone plate and screw flxation were
of mandibular injuries in this suburb of Taiwan performed. F
- 1 76一
台灣口外誌 Mandibular Fractures in Suburb of Taiwan
Fig. 1. A case 01" bilaleral condylar neck fracLUrc undcrwent rigid intermaxillary fixalion (A -C). A阮er 1
st
week and 3'" month follow up, the condyle heacl oSLeogcnesis and realign well (D)
177
Taiwan J Oral Maxillofac Surg 台獨口外誌
Fig. 2. .A. case of low-positioned, spitting-type subcondylar fracture (.A.) underwent two lag screws
fixation (8)
prescribed to all patients at the time of surgery, Follow-up examinations were recorded at
and their use was continued for 3 to 5 days aA:er intervals of 1, 2, 4, 6, and 12 weeks aA:er surgery,
the surgery. .A.丘er discharge, use of an enteral with additional examinations if necessary. Patients
antibiotic for 3 to 5 more days was prescribed. with less than 6 weeks of follow-up were excluded
.A.ge, etiology of injury, Injury Severity 什omthe study. .A. 6-week soA: diet was advised
Score, site of fracture, type of fracture, for all patients. The Erich arch bars were leA: in
associated midfacial fracture, and treatment were place postoperatively to facilitate guiding elastics
regarded as independent variables. .A. comminuted if necessary and then removed at the 4-week
fracture was detined as three or more fractured visit under local anesthesia at the outpatient
lines. .A. splitting fracture was defined as more c1inic. The follow-up variables include interdental
than 1 cm between two fracture lines. The contact checked by articulation paper, maximal
affected site was determined by the lowest border mouth opening checked by inter-incisor distance,
of the fracture line. The dependent variables were and mandible series or panoramic radiographs
set as the duration of postoperative hospital stay at intervals of 1, 4 and 12 weeks after surgery
and major postoperative complications, including Dental evaluation was performed in patients with
infection, malocclusion, nonunion, dehiscence, significant carious or periodontal destruction
osteomyel此時,and plate exposure. Those teeth meeting the following criteria were
- 178
台灣口外話、 Mandibular Fractures in Suburb of Taiwan
Fig. 3. A case口fcombinecl angle fr-aclure (A) and symphysis fraclure (B). 1 fe underwenl surgical fìxation
by 2.3 mm bonc plate system for symphysis ti'acture (C) and by l.3 mm miniplate syslem fOl
angle什acture(D). Postopcrative 4th week panoramic fìlm revealed bone gap was narrowing (E)
179
Taiwan J Oral Maxillofac Surg 台灣口外誌
extracted: (1) teeth with fractured roots (2) teeth Results
that were unsalvageable as a result of caries or
infection in the region of the fracture; and (3) This study included 67 patients (39 males,
teeth within the 仕acture line that were loose or 28 females) with 102 subsites of mandible
unstable. Stable teeth within the fracture line fracture, included 42 symphysis, 16 body, 15
were preserved for added reduction stability. angle, 12 subcondylar, 14 condylar, and 3
The outcome was evaluated at 12,h week. The alveolar fractures (Figure 4). The mean age
treatment morbidities are defined if there is of the pat悶nts was 31 土16 years (range, 10
uneven teeth contact, any clinical symptoms to 90 years). The most common etiology was
related to surgery, or bone malalignment on X-ray motorcycle accident (MCA) (72%, n=48),削lowed
finding. A statistical analysis using the chi-square by violence (9喘, n=6) and sliding (6%, n=4). Most
test and Fisher' s exact test was performed to of the patients were admitted by the ER (55帖,
determine the risk factors for prolonged hospital n=37) followed by trauma team referral (28%,
stay. The difference was regarded as significance n=19) and clinic referral (J 7%, n=l1). The median
if any the P value was less than 0.05. length of hospital stay was 7 days (range, 2 to 45
days)
Symphysis Body Angle Subcondyle Condyle Alveolus
Multiple sites
27 6 12 10 11 2
n=
Single site
16 10 3 2 3
n=
100%
80學6
60%
40%
20%
。%
Symphysis Body Angle Subcondyle Cor祖yle A惘。l喝
Fig. 4. Sixty• seven patients with 102 subsites of mandible 仕acture. The symphysis 佇acture combined
with posterior subsite企actureis the most common type of fracture
一18。一
台灣口外誌 Manclibular Fractures in Suburb of Taiwan
ln these 102 subsites of fracture, Illost the hospital stay after surgery was 5 days (range,
fractures were categorized as greenstick 01' 2 to 35 days). Fifteen (27施) patients required a
silllple (54%) followed by cOllllllinutecl (24%) prolonged post