Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil / Tempo de recuperação funcional após fraturas faciais: perfil e fatores associados em amostra de pacientes do sul do Brasil

ABSTRACT Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

RESUMO O entendimento da causa, da gravidade e do tempo decorrido para o restabelecimento das funções de lesões maxilofaciais pode contribuir para o estabelecimento de prioridades clínicas objetivando o efetivo tratamento e prevenção dos traumatismos de face. Assim, o objetivo deste estudo foi compreender quais os fatores associados ao restabelecimento das funções mastigatórias, oculares e nasais em vítimas de trauma de face, estimando o tempo para recuperação das funções, após o tratamento cirúrgico. Foram analisados 114 prontuários de pacientes atendidos no Hospital de Montenegro que compareceram às consultas de acompanhamento por até 180 dias. Para a análise do tempo para a recuperação, foi realizada a análise de sobrevida, seguida da análise de COX. Observou-se que metade dos pacientes recuperaram as funções em até 20 dias, sendo que o tempo médio para recuperação dos traumas no complexo zigomático-orbitário-malar-nasal foi de 11 dias e do complexo maxilo - mandibular de 21 dias (HR: 1,5 (0,99 - 2,3) p=0,055). Embora o restabelecimento das funções tenha atingido taxas elevadas após abordagem cirúrgicas, faz-se necessária a análise dos casos de insucessos bem como os impactos econômicos e as estratégias de prevenção associados aos traumas de face a fim de qualificar o serviço prestado à população.

Fracturas Mandibulares Conminutadas por Impacto de Proyectil Balístico: Propuesta de Tratamiento Inicial Mediante Método de Fijación Alternativo / Mandibular Fractures Comminuted by Ballistic Projectile Impact: Initial Treatment Proposal Using Alternative Fixation Method

RESUMEN: El trauma maxilofacial por arma de fuego representa un desafío terapéutico principalmente debido a la gran conminución de tejidos que genera. Específicamente, en casos de fracturas mandibulares conminutadas, las modalidades de tratamientos incluye la reducción cerrada, fijación con tutor externo, fijación interna con alambres y reducción abierta y fijación interna utilizando placas y tornillos. El objetivo del presente trabajo es describir un tratamiento inicial con un método de fijación para fracturas mandibulares conminutadas como dispositivo alternativo al tutor externo clásicamente utilizado. Se desarrolla una revisión de la literatura actual acerca del tratamiento inicial o de urgencia de fracturas mandibulares conminutadas por impacto de proyectil balístico, haciendo énfasis en las indicaciones de cada modalidad de tratamiento y sus respectivas ventajas y desventajas. Luego se describe detalladamente el proceso de confección de un método de fijación alternativo junto con la exposición de casos clínicos donde fue utilizado como alternativa de tratamiento. La reducción y fijación obtenida por el dispositivo presentado logra resultados satisfactorios, sin encontrarse diferencias significativas a los elementos de fijación clásicos. Tanto el uso de placas de reconstrucción como el de tutor externo constituyen alternativas válidas para el tratamiento de fracturas mandibulares conminutadas. El dispositivo descrito y utilizado en los pacientes es una alternativa eficiente, de fácil confección y bajo costo económico demostrando buenos resultados en relación a la consolidación de fracturas conminutadas. Se debe conocer las indicaciones para la aplicación de cada modalidad de tratamiento.

ABSTRACT: Ballistic maxillofacial trauma represents a challenge for surgeons because of the important comminution process it presents. Specifically, in cases of mandibular comminuted fractures, the different treatment modalities include closed reduction, external fixation and internal fixation. The purpose of this case series is to describe an initial treatment modality, with a fixation method for comminuted mandibular fractures as an alternative for the classic external fixator. We conducted a literature review about the initial treatment for ballistic comminuted mandibular fractures, emphasizing indications of each treatment modality and their respective advantages and disadvantages. Next, we described the preparation process of an alternative fixation method along with a case series, where it was used as a therapeutical alternative. The reduction as well the fixation achieved by the external fixator, showed satisfactory results without significant differences noted with traditional fixation methods. Both, reconstruction plates and external fixators, are valid alternatives for treating comminuted mandibular fractures. The method described and used in these patients is and efficient alternative, easy to make and at a low cost, with good results in relation to fracture consolidation. We propose that every treatment modality and its indications should be evaluated in order to treat each case adequately.

Tratamiento de fracturas mandibulares / Treatment of mandibular fractures

Las fracturas y secuelas mandibulares son de difícil resolución en el ámbito de la cirugía maxilofacial, sus componentes hacen que su reducción no solo sea anatómica, sino también funcional. El objetivo de este artículo es realizar una revisión de los conocimientos más actuales en el tratamiento de fracturas y secuelas mandibulares y la presentación de un caso de secuela de trauma mandibular. El trata-miento de estas fracturas ha ido cambiando durante los últimos años, sirviéndose de nuevas tecnologías para lograr una mejor reducción a través de elementos de osteosíntesis, que propician abordajes más pequeños y con menor comorbilidad. Así el los nuevos sistemas de placas de titanio como miniplacas, placas de reconstrucción o autobloqueantes brindan excelentes resultados en traumas de alta energía con reducciones anatómicas más estables. La tecnología a través de sistemas de reconstrucción 3D y TAC intraoperatorios han logrado mejores resultados en la resolución de estos traumas.

Treatment of mandibular fractures and their sequelae are difficult to resolve in the maxillofacial surgery field, their components cause that reduction must not only be anatomic, but functional as well. The aim of this article is to present a review about actual knowledge in mandibular fracture treatmentand report a case of mandibular trauma. The treatment of these fractures has been changing through theyears; the new technologies achieve better reduction with the osteosynthesis systems, which results inreduced approaches and lesser morbidity. Presently, titanium plates systems like mini-plates, reconstruction plates or blocking plates offer excellent results in high energy traumas through anatomic and stable reductions. The technology of 3D reconstruction systems and intra-operatory CT accomplishes better results in trauma treatment.

Osteomielitis causante de fractura patológica: reporte de un caso / Pathological fracture resulting from osteomyelitis: report of a case

Las fracturas patológicas mandibulares son poco comunes, representanel 1 a 2% de todas las fracturas. Pueden ser defi nidas como fracturasque ocurren en regiones donde el hueso ha sido debilitado bajo un procesopatológico. Los factores de causa más comunes incluyen procesosquirúrgicos tales como extracciones de terceros molares, colocación deimplantes, osteonecrosis relacionada con bifosfonatos, osteorradionecrosisde la mandíbula, osteomielitis, infecciones, tumores o lesionesquísticas. La osteomielitis es una condición infl amatoria del hueso; estapatología es uno de los factores que puede determinar el debilitamientodel hueso mandibular y causar una subsecuente fractura patológica. Laosteomielitis mandibular se puede desarrollar si una infección primaria noes manejada adecuadamente. El tratamiento de las fracturas patológicaspuede representar un reto para el profesional de la salud y difi ere segúnla etiología de la misma. Se presenta un caso de una paciente de 54 añosde edad, con una fractura mandibular patológica causada por osteomielitis,la cual fue tratada con antibioticoterapia e intervención quirúrgica.

Pathological mandibular fractures are rare, accounting for between1 and 2% of all fractures. They can be defi ned as fractures thatoccur in regions where the bone has become weakened as a result of a pathological process. Common causal factors include surgicalprocedures such as third molar removal, implant placement, bisphosphonate-related osteonecrosis, osteoradionecrosis of the jaw,osteomyelitis, infections, tumors, and cystic lesions. Osteomyelitisis an infl ammatory condition of the bone; this pathology is one ofthe factors that may prompt weakening of the mandibular boneand cause subsequent pathological fracture. Osteomyelitis of themandible may develop if a primary infection is not properly treated.Treatment of pathological mandibular fractures can be challengingand varies according to their etiology. This article looks at the caseof a 54-year-old woman with a pathological mandibular fracture caused by osteomyelitis, which was treated by means of antibioticotherapy and surgical intervention.

Fractura patológica por osteorradionecrosis de mandíbula: relato de caso / Pathological fracture due to mandibular osteoradionecrosis: A case report

La radioterapia es un tratamiento efectivo contra el cáncer, pero produce cambios en los tejidos adyacentes a las áreas irradiadas. En el hueso, la irradiación provoca hipoxia, hipocelularidad e hipovascularidad, haciendo que el tejido no sea capaz de regenerarse. Se presenta un caso de osteorradionecrosis ocurrido a causa de una extracción dental después de la radioterapia. Un hombre de 41 años con carcinoma epidermoide invasivo moderadamente diferenciado con sitio primario ubicado en suelo de boca en estado T4N2M0, fue sometido a radioterapia y quimioterapia. Después de 39 sesiones de radioterapia con 70 Gy, comenzó a quejarse de dolor en el diente en la mandíbula izquierda, que fue extraído por un dentista cirujano. Un mes después de la extracción, el paciente fue ingresado en el Hospital de la ciudad de Passo Fundo/RS, Brasil, con un absceso parafaringeo. El paciente diagnosticado con osteorradionecrosis fue tratado mediante cirugía para eliminar el secuestro óseo y lavado de los tejidos para el tratamiento paliativo de la lesión, pero después de 45 días murió debido al avance del cáncer. La osteorradionecrosis se puede evitar con un seguimiento odontológico que indique la adecuación del medio bucal y extracción oportuna de los dientes del área a irradiar

Radiotherapy is an established treatment modality in the management of malignant disease of the head and neck but promotes a significant marrow fibrosis and a paucity of cells as well as the ghosts of old blood vessels consistent with the concept of hypocellular­hypovascular­hypoxic tissue. The purpose of this article is to report a case of mandibular osteoradionecrosis (ORN) after dental extraction in a patient who had received radiotherapy. A 41-year-old male is presented with a history of squamous cell carcinoma in advanced stages of the floor of the mouth, staged T4N2M0, treated with concurrent chemotherapy and radiotherapy with 70 Gy of intensity modulate RT (IMRT). One month after IMRT, the patient presented with severe left tooth mandibular pain which was extracted. He was admitted to the Hospital da Cidade de Passo Fundo/RS, Brasil with complaint of infection of the left mandible with parapharyngeal abscess. The patient was diagnosed with osteoradionecrosis and treated with surgical procedure for removal of necrotic bone; the patient died 45 days following the last contact due to very advanced stage of the disease. The current risk of developing ORN is assumed to have declined. Good oral health status, especially after radiotherapy, is very important in the prevention of ORN. Teeth with unrestorable caries, those with periapical radiolucencies, or gross periodontal disease should be extracted before radiotherapy

Etiology of mandibular condylar fractures; a study from tertiary care hospital of Lahore

It is a cross sectional study conducted in a tertiary care hospital. Patients of condylar fracture reporting to oral and maxillofacial trauma center were evaluated radiographically [OPG, PA view and Lateral Oblique View] as well as clinically to record the etiology of mandibular condylar fractures. A total of 70 patients of 3 to 45 years of age were included in this study. The frequency of condylar fractures was higher in male of all age groups except for 11-20 years where females comprised of 55.5% of the cases. Among males, the highest frequency of fractures occurred in the third decade of life. Regarding the etiology of mandible condylar fractures, falls [45.71%] and RTA [40%] were found to be the most predominant causative factors, followed by industrial and occupational accidents [6%], Sports injuries [6%] and assault injuries [3%]. Falls were the etiologic factor in most of the cases which explains the association of falls with the mechanism of condylar injury. Road traffic accidents were the second common cause. Type 2 fractures which are low neck fractures with displacement were seen to be the most frequent

Characteristics of symphysis and parasymphysis mandibular fractures

This descriptive study was conducted to determine the most common site of mandible fractures. 200 patients with fracture mandible who reported to Department of Oral and Maxillofacial Surgery from April 2012 to September 2012 formed study group. Data concerning age, gender, mechanism of injury and site of fracture evaluated and recorded on specially designed proforma. Orthopentomogram [OPG] and where necessary postero- Anterior and right and left lateral oblique views of the mandible were used to diagnose the fracture site. Fracture mandible was predominantly common in males [84%] as compared to females [16%] with male to female ratio of 5.25:1. The age range was 2-65 years with mean age of 21.45 S.D +/- 12.59 years. The most common age group involved was 21-30 years [30%] and road traffic accident was the common mechanism of injury [57%] followed by fall [31.5%]. Parasymphysis was the most common site when mandible was fractures at a single site i.e., 43%, while parasymphysis and angle fracture combination was observed in 31%. The study revealed that majority of the patients were young adult males. The most common etiological fracture was road traffic accident and isolated parasymphysis was the most common fracture site

Patterns and etiology of maxillofacial fractures in Riyadh City, Saudi Arabia

The aim of the present study was to study the etiologies and patterns of Maxillofacial fractures in patients treated in Riyadh City, Saudi Arabia, between 2007 and 2011. Data were obtained through a retrospective review of 237 patients admitted to the King Saud Medical City Dental Department with a diagnosis of maxillofacial trauma. After excluding patient files with incomplete or unclear records, and cases in which computed tomography showed no evidence of fracture, the files of 200 patients with a diagnosis of maxillofacial fracture were included in the study. For each case, patient's sex and age, pattern of facial fractures, and cause of injury were recorded on a data sheet. The data were transferred to an SPSS [ver. 16.0; SPSS Inc., Chicago, IL, USA] spreadsheet for statistical analysis. The chi-square test was used to test the association between two categorical variables or factors [age group, cause] with p value set at p < 0.05, and t-test value at < 0.05 and independent. Motor vehicle accidents were the most common cause of maxillofacial fractures in most age groups, especially in males. Within the study sample, mandibular fractures were significantly more common than middle-third facial fractures [56.4% vs. 43.6%; p= 0.006]. Among mandibular fractures, parasymphyseal fractures were most common [47%], followed by condylar fractures [35.3%]. Most [77.2%] middle-third facial fractures involved the zygomatic complex, and the incidence of such fractures differed significantly between male and female patients. p=0.72, not significant. Males were more prone to maxillofacial fractures, perhaps as a result of the conservative nature of Saudi society, as the rules of Saudi Arabia do not allow the females to drive. Motor vehicle accidents were the most common cause of maxillofacial fractures in patients aged

Pattern of mandibular fractures reported at Liaquat university hospital Hyderabad

The study was conducted to analyze the frequency, gender distribution, age groups, mechanism of accident and site involvement of mandibular fractures reported at liaquat university hospital Hyderabad. Retrospective study. The study was conducted in Department of Oral and Maxillofacial Surgery Liaquat University Hospital Hyderabad from March 2012 to March 2013. A data of 228 of patients who had been diagnosed with a mandibular fracture between March 2012 and March 2013 at the Liaquat University Hospital of Hyderabad, Oral and Maxillofacial Surgery Department was retrospectively reviewed. Patients data including gender, age, mechanism of accident, fracture sites were analysed. 166 [72%] male patients and 62 [27%] female patients were reported with mandibular fracture. Most common age group was between 30-40 years. Most common mechanism of accident was RTA in 153 [67%]cases followed by fall from height 42 [18%] cases. Most common site involved was Parasymphysis in 112 [49%] cases followed by angle in 51 [22%] cases. The result of this study shows that road traffic accident is most common cause of mandibular fractures in this region

Fractura mandibular como complicación de la exodoncia del tercer molar inferior / Mandibular fracture as a complication of lower third molar extraction

La exodoncia de los terceros molares retenidos es uno de los procedimientos más frecuentes en cirugía bucal y puede estar asociada con diferentes complicaciones, tales como alveolitis, infecciones secundarias, hemorragias y alteraciones nerviosas. La fractura de ángulo mandibular asociada con la extracción del tercer molar retenido es una complicación infrecuente que puede darse durante el acto quirúrgico, o bien en el postoperatorio inmediato. Presentaremos una serie de casos en los que la consecuencia del acto quirúrgico fue la fractura mandibular, estableciendo parámetros para el diagnóstico y tratamiento inicial de la complicación, así como para su resolución final.

Pediatrics mandibular fractures: a study on the involvement of canine region

This study was conducted to compare the frequency of mandibular canine region fractures with fractures of other regions of mandible in patients with un-erupted canines at the Department of Oral and Maxillofacial Surgery, Abbasi Shaheed Hospital Karachi form January 2002 to March 2004. A Non Probability Convenience sample of all patients with age 6-12 years presenting with mandibular fracture were included. The sample was categorized into two groups: Age 6-9 years with un-erupted canines and Age 10-12 years with erupted canines. The fracture site parameter was categorized into two groups: Fractures in Canine Region and Fractures in other regions of the mandible. Total study sample was 76 subjects. Mean age of the subjects was calculated as 8.57 years [SD 1.94]. Male to Female ratio was 2.6:1. The most common cause of injury was recorded as fall 51.3% followed by road traffic accident 35.5%, assault and sports injuries accounted for 6.6%. The most common overall site of fracture was canine region 44.7%. In the age group [6-9 yrs] the fractures occurring in canine region were 51.3% and 15.8% in [9-12 years group]. Significant association was found to exist between the age groups [6-9 Years, 9-12 years] and fracture groups [canine region fractures, other region fractures] pvalue< 0.05. This study clearly demonstrates that mandibular fractures occur commonly in children in the region of un-erupted canines supporting the evidence of an area of weakness in the mandibular canine region, especially during the mixed dentition period

Estudo epidemiológico das fraturas mandibulares em hospital público da cidade de São Paulo / Epidemiologic study of mandible fractures in a public hospital of São Paulo

OBJETIVO: Analisar a frequência epidemiológica de fraturas mandibulares correlacionando gênero, faixa etária, fatores etiológicos, localização anatômica, e tipos de traços de fratura. MÉTODOS: Estudo retrospectivo nos prontuários de 883 pacientes portadores de fraturas faciais, atendidos no Pronto Socorro do Hospital Geral de Vila Penteado, pelo Serviço de Cirurgia e Traumatologia Buco Maxilo Facial (São Paulo - Brasil), num período de três anos (janeiro de 2004 a dezembro de 2006). RESULTADOS: Dos 883 pacientes avaliados, 270 apresentaram fraturas mandibulares (30,5 por cento). O gênero masculino foi o mais acometido (76,7 por cento) na faixa etária de 20 a 29 anos (33,0 por cento), o fator etiológico de maior freqüência foi acidente com veículos automotores (35,2 por cento), o corpo da mandíbula foi a localização anatômica mais atingida (47,4 por cento) e os traços únicos prevaleceram (76,7 por cento). CONCLUSÃO: As fraturas, em sua maioria, foram simples (traço único), localizadas em corpo mandibular, e destacadas no sexo masculino, na faixa etária de 20 a 29 anos, além do que o fator etiológico mais comum foi acidente com veículos automotores.

OBJECTIVE: To analyze the frequency epidemiological description of mandibular fractures correlating gender, age, etiological factors, anatomic location, and types of fracture's traces. METHODS: A retrospective survey of the medical history of 883 patients with facial fractures, attended at the Buco-Maxilo-Facial Surgery and Traumatology Service of the Hospital Geral de Vila Penteado in São Paulo (São Paulo - Brazil), in a period of 3 years (from January 2004 to December 2006). RESULTS: From 883 patients evaluated, 270 presented mandibular fracture (30,5 percent). The male gender was the most affected (76,7 percent) in the age of 20 to 29 years (33,0 percent), the most frequent etiological factor was the car accident (35,2 percent), the body of the mandible was the most affected anatomic location (47,4 percent) and the single traces prevailed (76,7 percent). CONCLUSION: The majority of the fractures were simple, located in the body of the mandible, and higligted in males, aged from 20 t0 29 years, and caused by car accident.

Aspectos imaginológicos de alterações em articulações temporomandibulares relacionadas a traumatismos ocorridos na infância / The role of image exams at temporomandibular joint changes associated with trauma in childhood

Traumatismos são frequentes na região da articulação temporomandibular (ATM), principalmente na infância. O objetivo deste trabalho é ressaltar algumas possíveis sequelas provenientes desses traumas e fornecer ao cirurgião-dentista informações quanto aos exames de imagens indicados para esta situação, dando ênfase à ressonância magnética e à tomografia computadorizada.

Trauma at temporomandibular joint are frequently, especially in childhood. The purpose of this study is highlight some complications that might occur because of trauma and provide informations about the image exams that are indicated for this situation, emphasizing magnetic resonance and computed tomography.

Pattern of mandibular fractures: a study

This descriptive study was conducted to evaluate and analyze the pattern of mandibular fractures in 150 patients treated in the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar from 1[st] Sep 2004 to 31[st] Dec 2005. These patients were examined both clinically and radiologically for mandibular fractures. Data concerning age, gender, causes of fracture and sites of fracture were evaluated and reviewed. The age range was 2-78 years [mean 24 years] with high frequency occurring in 21-30 years age group. The male to female ratio was 4.1:1. The leading cause of mandibular fracture was road traffic accident [RTA [n=64; 42.6%]], followed by accidental fall [n= 42; 28%], firearm injury [FAI [N=25; 16.6%]], assault [n=7; 4.6%], sports [n=5; 3.3%], industrial accidents [n=3; 2%] while 4 cases were associated with other causes such as bomb blasts and animal injury. The most common site was parasymphysis [n= 47; 27.4%] followed by angle [n=40; 23.3%] and body [n=38; 22.2%]. This study can guide us to formulate strategies and policies to prevent and treat mandibular fractures

Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6 percent) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6 percent). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7 percent of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma.

Fraturas mandibulares: uso de miniplacas ou fios de aço? estudo comparativo / Mandibular fractures: miniplates versus steel wires: a comparative study

Através de um levantamento bibliográfico o autor discute as vantagens e desvantagens da utilização da Fixação Interna Rígida quando comparada a osteossíntese a fios de aço, comprovando a superioridade técnica, a menor incidência de infecções pós-operatórias e o menor custo de tratamento da Fixação Interna Rígida em relação a Ostessíntese a Fios de Aço.

The autor through a medical literature study dicusses and evaluates the advantages and disadvantages of the use of Rigid Internal Fixation when compared to Wire Osteosynthesis demonstrating that Rigid Internal Fixation is better taking into consideration the technical point of view than Wire Osteosynthesis on account of the lower incidence of infections and the cost benefit.

Frequency of mandibular fractures at the angle as a result of maxillofacial trauma

The aim of this study was to determine the vulnerability of the angle of mandible to fracture in maxillofacial injuries. The etiological factors, distribution of age and gender of the patients with mandibular fracture were investigated. 750 patients were seen for maxillofacial trauma during the period 1991-97 at Khyber College of Dentistry, Peshawar. Out off 750, 546 suffered from mandibular fracture. 412 were males and 134 females. Regarding etiology of the fracture of the mandible road traffic accident [RTA] was the most common cause accounting 356 followed by fall 78, interpersonal violence [IPV] 47, firearm injuries [FAI]29, sports 23 and industrial injuries 13. Fracture of the body of mandible came out to be the frequent site [185 patients] suffered. Angle of the mandible was second most common site and accounted for 125 injuries. Other sites were symphysis [97], condyle [82], dentoalveolar process [38], ramus 16 while coronoid was the rare site [3] patients. Out of the 125 fractures cases at the angle 3[rd] molar were present in 108 cases. Among the total fractures at the angle 102 were favorable while 23 were unfavorable

Características e distribuição das fraturas mandibulares por causas externas: estudo retrospectivo / Characteristics and distribution of mandibular fractures due to external causes: a retrospective study

Objetivo: Analisar as características e a distribuição das fraturasmandibulares por causas externas no Hospital Regional de CampinaGrande/PB, no período de Janeiro de 2002 a Dezembro de 2006.Método: Por meio da observação indireta foram examinados 691prontuários médico-hospitalares do Serviço de CirurgiaBucomaxilofacial, dos quais 59 (8,5 por cento) referiam-se a vítimas defraturas mandibulares. Foram analisadas as variáveis: gênero, faixaetária, período da ocorrência (dia e horário), etiologia, presença defraturas associadas, tipo de tratamento e o tempo de internação.Resultados: Os resultados mostraram o gênero masculino o maisacometido (83,1 por cento), sendo a faixa etária de 21-30 anos a maisafetada (40,7 por cento). Os atendimentos ocorreram com maior freqüênciaaos sábados e domingos (40,6 por cento) e à noite (30,5 por cento). A queda(28,8 por cento), violência interpessoal (23,7 por cento) e o acidente de motocicleta(23,7 por cento) foram as principais etiologias. Cinco pacientes (8,5 por cento)apresentaram fraturas em outros ossos da face, com o uso de fiode aço com bloqueio intermaxilar se constituindo no tratamentomais freqüente (50,8 por cento). O tempo médio de internação foi de 5,28dias.Conclusão: A prevalência de fraturas mandibulares é maior nogênero masculino, durante a terceira década de vida; sendo aqueda o principal fator etiológico, com a maioria dos casosocorrendo no fim de semana.

Epidemiologie des fractures de la mandibule traitees au Centre Hospitalier Universitaire d'Antananarivo - Madagascar

Justification: Les fractures de la mandibule font partie des lesions traumatiques de la face. Les causes sont constituees par les violences interpersonnelles; les accidents de la route et les chutes. A Madagascar; nous ne disposons pas encore de donnees concernant les fractures de la mandibule. Alors; nous avons voulu mener a terme cette etude. Objectif: L'objectif de cette etude est de determiner l'epidemiologie des fractures de la mandibule a Antananarivo - Madagascar.Patients et methodes: Nous avons realise une etude retrospective des dossiers medicaux et des cliches radiographiques des malades porteurs de fractures de la mandibule traites au service de Chirurgie maxillo-faciale du Centre Hospitalier Universitaire (CHU) d'Antananarivo - Madagascar - durant 3 ans et demi. Resultats: Parmi 2363 consultants; 170 ont presente au moins une fracture de la mandibule (77;27) sur 220 cas de traumatisme maxillo-facial. Cent trente sept (80;58) cas sont de sexe masculin. Ces fractures surviennent a tout age avec une nette predominance des jeunes de 21 a 34 ans (59;41). Les causes des fractures et les circonstances de survenue sont dominees par les violences interpersonnelles avec 55;88(traumatisme direct par coup de poing ou par objet contondant); puis les accidents de la voie publique (victimes a l'interieur des vehicules ou sur les 2 roues). Le trait de fracture est unique dans 130 cas (76;47); double dans 37 cas (21;76) et le foyer et triple dans 3 cas. Les fractures de l'angle sont les plus rencontrees dont plus de 70sont a gauche. Conclusion : Cette etude montre la frequence elevee des fractures mandibulaires engendrees par les agressions et aussi leur survenue chez les hommes jeunes