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British Journal of Oral and Maxillofacial Surgery 46 (2008) 126–127

Short communication
Pattern of mandibular fractures in Chennai, India
K. Subhashraj ∗ , S. Ramkumar, C. Ravindran
Department of Oral and Maxillofacial Surgery, Sri Ramachandra Dental College and Hospital,
Sri Ramachandra Medical College and Research Institute, Porur, Chennai 600 116, India

Accepted 6 October 2006

Available online 13 November 2006

Abstract

We describe the pattern of mandibular fractures in Chennai, and confirm that, as in most other large cities, the main cause is road traffic
accidents.
© 2006 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Keywords: Maxillofacial; Mandibular; Fractures; Facial trauma

Introduction Results

Despite the fact that the mandible is the largest and strongest
facial bone, it is fractured two or three times more often than
other facial bones.1 The variability in the pattern of fractures
results from the different causes of injury such as road traffic
accidents (RTA), assault and falls.2,3
Despite many reports about the incidence, diagnosis and
treatment of mandibular fractures, there is limited knowl-
edge about the specific type or pattern of mandibular fractures
related to RTA in Asian countries.
Patients and methods
The medical records of all the patients who reported to the Sri
Ramachandra Medical and Dental College, Chennai, between
October 2000 and September 2004 were reviewed. Data
about age, sex, cause of injury, anatomical location, seasonal
variation, treatment, and postoperative complications were
collected.
Of the 1842 patients with maxillofacial injuries, 238 patients
(13%) had mandibular fractures. Their ages ranged from 6 to
89 years, and there were 192 men and 46 women (ratio 5.1:1).
The main cause was RTA, particularly in those travelling on
motorcycles (Table 1).
More incidences of mandibular fractures were seen during
the months of September (32/238) and October (29/238). The
total number of mandibular fractures was 443 in 238 patients,
mean 1.9 fractures/mandible. The sites of the fractures are
shown in Table 2.
Of the 238 patients who had mandibular fractures, in
151 (64%) the mandible was the only facial bone that was
involved. The most commonly associated fracture was that of
zygomaticomaxillary complex (n = 66) followed by Le Fort
type fractures (n = 47). Of the total number of mandibular
fractures, 108 patients had only one fracture, while 118 had
two fractures, and 12 had three fractures. Most patients with
two or three fractures had had an RTA (n = 142).

Discussion

∗ Corresponding author at: 10, 8th cross, Brindavan, Pondicherry 605013, The results of this study of mandibular fractures con-
India. Tel.: +91 413 2225992/98941 89339. firm previous reports, particularly regarding age and sex of
E-mail address: rajsubhash@rediffmail.com (K. Subhashraj). patients.3–7 The highest incidence of mandibular trauma was

0266-4356/$ – see front matter © 2006 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2006.10.004
 K. Subhashraj et al. / British Journal of Oral and Maxillofacial Surgery 46 (2008) 126–127 127

Table 1 lar fracture. However, Olson et al.8 showed that there was
Distribution of fractures according to aetiology
a higher incidence of angle involvement in patients with
Cause Number (%) mandibular fractures.
Motorcycles 171 (71) Open reduction and internal fixation was done for 198/238
Cars 35 (15) patients (83%) and closed reduction for 40 patients (17%).
Assaults 13 (6)
Miscellaneous 19 (8)
Postoperative complications (infection, malocclusion and
malunion) developed in 12 (5%), which is lower than reported
Total 238
other developing countries.4,7
During this period the highest incidence of mandibular
Table 2 fracture was during the months of September and October.
Distribution of fractures according to anatomical location
Most patients with mandibular fractures were seen on Satur-
Site Number (%) days, particularly late in the day.
Parasymphysis 156 (35) Socioeconomic reasons such as poor roads, inadequate
Condyle 98 (22) enforcement of road safety regulations and speed limits,
Angle 51 (12)
Dentoalveolar 48 (11)
reluctance to use helmets, decreasing tolerance and increas-
Symphysis 46 (10) ing personal competitiveness among young men, could be the
Body 26 (6) possible explanations, in particular in this part of the country.
Ramus 12 (3)
Coronoid 6 (1)
Total 443 References

Table 3 1. Haug RH, Prather J, Indreasano AT. An epidemiological survey of frac-

Distribution of fracture according to age tures and concomitant injuries. J Oral Maxillofac Surg 1990;48:926–32.
2. Scherer M, Sullivan WG, Smith DJ, et al. An analysis of 1423
Age (years) Number (%) facial fractures in 788 patients at an urban trauma center. J Trauma
0–10 15 (6) 1989;29:388–90.
11–20 22 (10) 3. Thorn JJ, Mogeltoft M, Hansen PK. Incidence and aetiological pattern of
21–30 78 (33) jaw fractures in Greenland. Int J Oral Maxillofac Surg 1986;15:372–9.
31–40 43 (18) 4. Mwaniki DL, Guttua SW. Occurrence and characteristics of mandibular
41–50 41 (17) fractures in Nairobi, Kenya. Br J Oral Maxillofac Surg 1990;28:200–20.
51–60 29 (12) 5. Adi M, Ogden GR, Chisholm DM. An analysis of mandibular frac-
>61 10 (4) tures in Dundee, Scotland (1977 to 1985). Br J Oral Maxillofac Surg
1990;28:194–9.
Total 238 6. Ogundare BO, Bonnick A, Bayley N. Pattern of mandibular fractures in
a urban major trauma center. J Oral Maxillofac Surg 2003;61:713–8.
7. Oji C. Jaw fractures in Enugu, Nigeria, 1985–1995. Br J Oral Maxillofac
in the age group 21–30 years (28%) (Table 3). Although RTA
Surg 1999;37:106–9.
is still the common cause of maxillofacial trauma in develop- 8. Olson RA, Fonseca RJ, Zeitler DZ, Osbon DB. Fractures of the
ing countries, assault is the most common cause in developed mandible. A review of 580 cases. J Oral Maxillofac Surg 1982;40:23–8.
countries.7–10 In 209 of our patients, RTA was the cause of 9. Ellis III E, Moos KF, el Attar A. Ten years of mandibular fractures: an
injury. analysis of 2137 cases. J Oral Surg 1985;59:120–9.
10. Fridrich KL, Pena-Velasco G, Olson RA. Changing trends with
The pattern of presentation is shown in Table 2. This is
mandibular fractures: a review of 1067 cases. J Oral Maxillofac Surg
consistent with the report of Adi et al.5 who showed that 1992;50:58–90.
the symphyseal region is the most common site of mandibu-