Epidemiology of mandibular fractures treated at Kaunas University of Medicine Hospital, Lithuania.
ABSTRACT Fractures of the mandible are one of the most common maxillofacial injuries. Because the pattern and incidence of mandibular fractures vary in different countries, there is a need to evaluate aspects of mandibular trauma in Lithuania's population. In this retrospective study hospital files of Oral and maxillofacial surgery unit of Kaunas University of Medicine Hospital were examined. The data that we collected included age, gender, hospitalization time, trauma mechanism, site of fracture, associated injuries, diagnostic and treatment methods. 87.1% of patients were male and they predominated in all age groups with a male to female ratio of 6.8:1. The highest incidence of mandibular fractures in male patients was in the 16-30 year age group and 31-45 year group for females. Interpersonal violence was the main cause of mandibular fractures, followed by falls and road traffic accidents. The incidence of falls in the <16 year age group was higher than expected. The angle was the most common fracture site (34.8%) and 51.7% patients experienced multiple fractures. The mean hospitalization time was 7.34+/-9.02 days. 55% of patients required Kirschner wire osteosynthesis, open reduction with miniplate osteosynthesis or a combination of both methods.
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ABSTRACT: Mandible fractures are among the most frequently seen injuries in the trauma center setting. Recent shifts in the mechanism and age distribution of patients sustaining these injuries are well documented. This study attempts to define current, predictable patterns of fracture based on patient characteristics and mechanism of injury. The charts of 134 patients with 225 mandible fractures treated over a 7-year period by the Otolaryngology-Head and Neck Surgery, Plastic and Reconstructive Surgery and Oral-Maxillofacial Surgery services, our institution, were retrospectively reviewed. Patients were categorized based on age, mechanism of fracture, and anatomic location of fracture. Multivariate analysis of data was performed to determine significant relationships among groups. Violent crimes such as assault and gunshot wounds accounted for the majority of fractures (50%) in this study, with motor vehicle accidents less likely (29%). Overall, parasymphyseal fractures were most frequent (35%), whereas angle and body fractures were also common (15% and 21%, respectively). There was a statistically significant association of motor vehicle accidents with parasymphyseal fractures (45%), and gunshot wounds with body fractures (36%), whereas assault victims had a higher than predicted frequency of angle fractures (27%) and fewer parasymphyseal fractures (19%). Patients aged 17 to 30 were more likely to suffer from gunshot wounds, whereas older adults (age 31-50) were more likely to be assault victims. Patients over age 50 suffered fractures from falls at a higher than expected rate. Although children and young adults seemed to suffer more parasymphyseal fractures and older adults body fractures, these correlations failed to show statistical significance. Parasymphyseal fractures were most frequently associated with fractures at other sites within the mandible, ipsilateral body fractures being the most common. Updated data on the association of patient age and mechanism of injury with fracture pattern can guide treating physicians in anticipating and diagnosing traumatic mandible fractures.American Journal of Otolaryngology 25(5):301-7. · 0.87 Impact Factor
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ABSTRACT: The objective of this investigation was to determine the causes and incidence of maxillofacial fractures in the country of Jordan. A retrospective review of patient records and radiographs for the 5-year period from 1992 to 1997 was conducted. Data regarding age, gender, cause of fracture, anatomic site, and treatment modalities were reviewed. During the 5-year period, 563 patients with 756 maxillofacial fractures were treated. The age range was 5 to 73 years (mean, 28.8 years). Of the 563 patients, 75.3% were male, with the peak incidence occurring in the age group 20 to 29 years. The bone of fracture was most frequently the mandible (seen in 419 cases, or 74.4% of the total), followed by the maxilla (76 cases; 13.5%), the zygomatic arch (60 cases; 10.7%), and the alveolar process (8 cases; 1.4%). Of the fractures, 55.2% were due to traffic accidents, 19.7% to accidental falls, and 16.9% to assaults. Most patients (82.3%) were treated by closed reduction surgery (45.2% with eyelet wiring; 54.8% with arch bars and intermaxillary fixation). Only 17.7% of patients were treated by open reduction surgery. All maxillary fractures were treated by orbital and circumzygomatic suspension with interdental wiring and intermaxillary fixation. Of the zygomatic complex fractures, 26 cases were treated with Gillies' temporal approach, 20 with percutaneous hook elevation, and 14 with observation alone. The findings support the view that both the causes and the incidence of maxillofacial fractures vary from one country to another.Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 08/1998; 86(1):31-5. · 1.46 Impact Factor
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ABSTRACT: There are considerable differences in the reported worldwide pattern of maxillofacial fractures. In the more developed countries of Europe, violence followed by road crashes are the predominant causes while in the developing world the causative factors are reversed with most being the result of road crashes. Interestingly, recent data indicated a 3:1 male:female ratio worldwide. Between 1991 and 2000, 443 cases of maxillofacial fractures were seen at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Road crashes were responsible for 246 cases (56%) followed by falls, 24% (n=108). In a previous report from this centre in 1980, 241 fractures were seen each year, so our lower rate of 44 cases a year is because the number of centres for the treatment of such injuries in Nigeria has increased. There has also been a fourfold increase in the number of women with facial fractures in this largely Moslem population, which reflects their greater exposure during the past 20 years. More patients were seen with mandibular than middle-third fractures, because more of the latter died. This shows that while more centres for treatment are available for patients with maxillofacial trauma, the lack of enforcement of legislation on the use of seat belts, drunken driving and inadequate emergency medical care have continued to cause considerable mortality and morbidity from these injuries in Nigeria. It is also difficult to compare data among centres because of inconsistent terminology.British Journal of Oral and Maxillofacial Surgery 01/2004; 41(6):396-400. · 1.95 Impact Factor
Stomatologija, Baltic Dental and Maxillofacial Journal, 2009, Vol. 11, No. 3 73
Stomatologija, Baltic Dental and Maxillofacial Journal, 11:73-76, 2009
Fractures of the mandible are one of the most common maxillofacial injuries. Because the
pattern and incidence of mandibular fractures vary in different countries, there is a need to
evaluate aspects of mandibular trauma in Lithuania's population. In this retrospective study
hospital files of Oral and maxillofacial surgery unit of Kaunas University of Medicine Hospital
were examined. The data that we collected included age, gender, hospitalization time, trauma
mechanism, site of fracture, associated injuries, diagnostic and treatment methods. 87.1% of
patients were male and they predominated in all age groups with a male to female ratio of 6.8:1.
The highest incidence of mandibular fractures in male patients was in the 16-30 year age group
and 31-45 year group for females. Interpersonal violence was the main cause of mandibular
fractures, followed by falls and road traffic accidents. The incidence of falls in the <16 year
age group was higher than expected. The angle was the most common fracture site (34.8%)
and 51.7% patients experienced multiple fractures. The mean hospitalization time was 7.34±9.02
days. 55% of patients required Kirschner wire osteosynthesis, open reduction with miniplate
osteosynthesis or a combination of both methods.
Key words: mandibular fractures, condyle, interpersonal violence.
Epidemiology of mandibular fractures treated at Kaunas
University of Medicine Hospital, Lithuania
Ricardas Kubilius,Tadas Keizeris
Mandible is the only mobile bone of the facial
skeleton and its anatomical features make this bone
important in speech, mastication and respiration.
Skeletal and soft tissues of the face region are prone
to injuries as it is the most exposed part of the body
. Many authors report mandibular fractures as
the most common site of maxillofacial fractures, fol-
lowed by the zygomatic complex [1,2] and majority
of patients fall in the 20-29 year age group [1-3,9-
15].The most common causes of mandibular frac-
tures remain interpersonal violence (IPV), road traf-
fic accidents (RTA), sports and falls with a domi-
nance of IPV [3,4], while some authors point out
RTA as the main cause [5,6]. The purpose of this
retrospective study is to evaluate current pattern and
aetiology of mandibular fractures in middle, south-
western and northwestern Lithuania and provide
detailed information about some aspects of mandibu-
MATERIAL AND METHODS
In this study data of 916 patients who reported
to Kaunas University of Medicine Hospital Oral and
maxillofacial surgery unit during a 3 year period (Janu-
ary of 2005 to January of 2008) with radiographically
and clinically confirmed mandibular fractures were
analyzed. 5 patients (.5%) had partially incomplete
data but were included in data analysis. Patient de-
tails were reviewed retrospectively by examining
hospital files. The following data were collected: age,
gender, hospitalization time, trauma mechanism, site
of fracture, associated injuries, diagnostic and treat-
A database was created in Microsoft Excel.
The statistical analysis was performed and results
were tested for statistical significance using SPSS
15.0 for Windows. Statistical analyses included de-
scriptive statistics, Student’s t-test to compare two
groups, χ2 test for bivariate associations and
ANOVA followed by Bonferonni test for multiple
comparisons. Some results were presented as
*Department of Maxillofacial Surgery, Kaunas University of Medi-
cine, Kaunas, Lithuania
Ricardas Kubilius* – D.D.S., dr.hab.med., professor, Head of
Department of Maxillofacial Surgery
Tadas Keizeris* – postgraduate student in medicine
Address correspondence to: Tadas Keizeris, Sviesos str. 20-3, LT-
50281, Kaunas, Lithuania.
E-mail address: email@example.com
74Stomatologija, Baltic Dental and Maxillofacial Journal, 2009, Vol. 11, No. 3
R. Kubilius,T. KeizerisSCIENTIFIC ARTICLES
mean ±1.96×standard deviation (95% confidence
798 patients were male (87.1% of the popula-
tion) and 118 patients were female (12.9%) with a
male to female ratio of 6.8:1. The patients’ age ranged
from 1 to 85 years. Mean age of male patients was
31.21±24.24 years and female 35.15±26.63 years and
this difference was statistically significant (p=.001).
The highest incidence of mandibular fractures was
in the 16-30 year age group (50.2%), followed by the
31-45 year age group (32.8%) (Figure 1). Men out-
numbered women in all the age groups with statisti-
cal significance in 16-30 and 46-60 age groups (p<.05).
The preponderant cause of mandibular fractures
was IPV (71.8%), followed by falls (12.3%) and RTA
(6%). The highest incidence of falls was in the <16
year age group at a higher than expected rate. The
highest percentage of male and female patients was
in IPV (64.6% and 7.2% respectively) and there were
no female patients in sports (Table 1).
A total of 916 patients had 1429 mandibular frac-
tures. The most common fracture site by anatomical
location was the angle (497 cases, 34.8%), followed
by body (382 cases, 26.7%) and condyle (327 cases,
22.9%). 442 patients had isolated fractures (48.3%),
among which the commonest was the angle (219
cases, 49.5%) and condyle (97 cases, 21.9%). The
dominant fracture site in male patients was the angle
(447 cases, 36.1%) and in female patients the man-
dibular body (61 cases, 31.9%) (Figure 2). Angle, body
and parasymphysis fractures statistically significantly
occurred more often in male than female patients
(p<.05). The most common combination of fractures
was body and angle (137 cases, 15%), followed by
body and condyle (86 cases, 9.4%) and
parasymphysis and condyle (43 cases, 4.7%). There
were 396 bilateral fractures (43.2%) and right side
mandibular fractures were significantly more frequent
in male patients (95% CI, p=.0004).
69 patients (7.5%) had 102 concomitant maxillo-
facial fractures, the most common of which was na-
sal bone and zygomaticomaxillary complex (25 cases
each, 24.5% each), followed by maxillary bones (18
cases, 17.6%) and zygomatic complex (9 cases,
8.8%). Preponderant cause of these fractures was
IPV (54.7%), followed by RTA (22.1%) and falls
Mean hospitalization time was 7.34±9.02 days.
Patients with one fractured mandible site had the
shortest hospitalization time (6.74±4.12 days) and the
longest (10.86±7.87 days) was for patients with 3
fracture sites (Table 2). There was a statistically sig-
nificant association between the number of fracture
sites and increasing hospitalization time, except those
who had 4 fracture sites of the mandible (Table 3).
Fig. 1. Distribution of mandibular fractures by age and gender
Stomatologija, Baltic Dental and Maxillofacial Journal, 2009, Vol. 11, No. 3 75
SCIENTIFIC ARTICLESR. Kubilius,T. Keizeris
The most common mandibular fracture diagnos-
tic method was anteroposterior craniogram combined
with orthopantomogram (65.5%). Only anteroposte-
rior craniogram was taken for 9% of patients and
orthopantomogram for 24.9% of patients.
Conservative treatment (intermaxillary fixation)
as initial therapy was applied to 685 (74.8%) pa-
tients and for 374 of these patients (54.6%) it was
successful. Kirschner wire osteosynthesis, open re-
duction with miniplate osteosynthesis or a combina-
tion of both methods were required by 55% of all
patients, including those whom conservative treat-
ment was not sufficient, and the most common
method (70.6%) was open reduction with miniplate
osteosynthesis. When there was more than one frac-
ture site, active treatment was required in 58.2% of
patients, statistically significantly more than com-
pared to 51.5% of patients having one fracture site
of the mandible (Table 4). 12 patients (1.3%) re-
fused of active treatment.
The causes and incidence of maxillofacial frac-
tures varies according to geographical region, culture,
siocioeconomic status, religion and era [6,7]. In this
study men were injured more common and this ten-
dency corresponds to previously published reviews,
although male to female ratio varies in different re-
gions [7-14]. The majority of patients (50.2%) were
in the 16-30 year age group and this also supports
international trends of mandibular trauma [9-15]. K.
H. Lee  reported falls as a category which ac-
counted for most mandibular fractures in the >60 year
age patient group. Contrary to these data we found
falls to be responsible for 45.8% (more than expected)
of fractures in the <16 year age group and this dif-
ference was statistically significant compared to all
age groups (95% CI, p≤.001). IPV in this age group
also accounted for 45.8% (less than expected) of
mandibular fractures with a statistically significant
difference among all other age groups (95% CI,
p≤.012) except >60 year age group (95% CI, p=.151).
Such results might show a possibility that teenagers
tend to report violence as falls because of fear or
other reasons. This requires closer investigation.
However, we got a striking similarity with K. H. Lee
regarding sports. He observed 74% of all sport-re-
lated fractures affecting young adults in the 16-30
year age group, compared to 75% of sport injuries
falling in the 16-30 year age group in our review.
Many authors have reported road accidents as
the main cause of mandibular fractures [5,6,10,14],
Fig. 2. Site of mandibular fractures
Table 1. Distribution of mandibular fractures by aetiology
Daily activities 32 (3.5%)
IPV – interpersonal violence; RTA – road traffic accident.
Table 2. Mean hospitalization time according to number of
No of fracture sites
Mean hospitalization time (days)
6.74 ± 8.08
7.61 ± 8.96
10.86 ± 15.42
8.00 ± 9.99
Table 3. Mean difference of hospitalization time according to
number of fractures
No of fracture sites
1 – 2
1 – 3
1 – 4
2 – 3
2 – 4
3 – 4
p (95% CI)
CI – confidence interval.
Table 4. Treatment methods used in cases of one and more
than one fracture sites
IW followed by KW 79 (17.8%)
IW followed by
IW followed by
KW and ORMO
10 (2.3%) 13 (2.8%) .3037
228 (51.5%) 273 (58.2%) .0203
IW – interdental wiring; KW – Kirschner wires; ORMO – open re-
duction with miniplate osteosynthesis; CI – confidence interval.
76Stomatologija, Baltic Dental and Maxillofacial Journal, 2009, Vol. 11, No. 3
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R. Kubilius,T. KeizerisSCIENTIFIC ARTICLES
while others have reported IPV as the main cause
and confirms our results [3,4,12]. This difference is
usually explained by different geographical region,
culture, siocioeconomic status and religion.
We found a statistical significant tendency of
hospitalization time increase proportionally to the num-
ber of fracture sites of the mandible, except in the
group of 4 fracture sites. This might be explained by
a small patient population (4 patients, one of them
left the hospital without permission after 3 days) in
the aforesaid group.
King R. E. et al  reported a statistically sig-
nificant association between motor vehicle accidents
and parasymphyseal fracture and between assault and
angle fracture. In our population the highest incidence
of condylar fracture was in RTA, angle fracture oc-
curred most often in sports and IPV.
According to King R. E. et al , mandibular
fractures more often occur in multiple sites. 51.8%
of patients in our study had more than one fracture
site, among which the highest incidence was in RTA
(67.9%), followed by IPV and falls (52.9% and
Most fractures which required active treatment
were caused by IPV (70.6%), but the highest inci-
dence of active treatment was related to RTA
(75.5%). More than half of conservative treatment
cases appeared to be successful and the rest 45.4%
of patients were treated with Kirschner wires or/and
open reduction with miniplate osteosynthesis.
The leading cause of mandibular fractures is in-
terpersonal violence and most of the affected patients
are young men. There is a need of further investiga-
tion for possible associations between mandibular in-
juries and other contributing factors.
Received: 24 06 2009
Accepted for publishing: 28 09 2009