Undiagnosed mandibular condylar fractures causing temporomandibular joint ankylosis: A problem in northern India.

ABSTRACT

Background.Temporomandibular joint (TMJ) ankylosis due to undiagnosed condylar fractures has a high incidence in India compared to western countries. We evaluated the demographics, injury pattern, hospital reporting and referral pattern of undiagnosed condylar fractures complicating TMJ ankylosis in northern India. Methods.We did a retrospective analysis by retrieving medical records of patients with post-traumatic TMJ ankylosis reporting to the Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences between 1July 2012 and 30June 2013. Results. Of 90 patients with post-traumatic TMJ ankylosis, 74 (82.2%) resided in rural areas. Sixty-three (70%) patients were from the states of Uttar Pradesh, Bihar and Jharkhand. Only 8.8% had higher education and 10% had an annual income of more than `2 lakh. In 69 (84.4%) patients, fall was the aetiological factor. Primary health centres (42%) and private clinics (20.5%) received the major share of patients immediately following injury. Few patients (19.3%) had some radiographic examination done and only 17% were referred by the primary healthcare provider. Of those referred only 3 were examined by a dental practitioner. Only 10% of all were diagnosed with condylar fractures. Conclusion.Patients with TMJ ankylosis presenting to us have poor literacy and income levels. A missed diagnosis of condylar fractures by rural healthcare providers contributes to its high incidence in India. Improving awareness of clinicians and improved rural healthcare infrastructure can help prevent this complication.