Two-Year Treatment Outcomes of Mandibular Fractures in a … · 2012-03-30 · mandibular fractures between 2009 and 2010 at the Department of Oral and Maxillofacial Surgery, Chi-Mei

$Page 1: Two-Year Treatment Outcomes of Mandibular Fractures in a … · 2012-03-30 · mandibular fractures between 2009 and 2010 at the Department of Oral and Maxillofacial Surgery, Chi-Mei$
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台灣口外誌 Mandibular Fractures in Suburb of Taiwan

Two-Year Treatment Outcomes of Mandibular Fractures in a Suburban Hospital of Taiwan

Chih-Wen Cheng1, Rong-Wu Yong1, Che-Yi Lin1, Min-Te Chang2,

Chun-Jung Chen1, Wei-Fan Chiang1,3

1 Department of Dentistry, Chi-Mei Medical Center, Liouying, Tainan, Taiwan 2 Department of Dentistry, Chi-Mei Medical Center, Yongkang, Tainan, Taiwan

3 School of Dentistry, National Yang-Ming University, Taipei, Taiwan

Abstract

Purpose: The etiology, type, and surgical outcomes of mandibular fractures in Taiwan have rarely been described. A study of the current trends in mandibular fractures at a suburban hospital would help clinicians and public health researchers better understand the differences between urban and suburban mandibular fractures and to design appropriate treatment strategies. Patients and Methods: This retrospective study analyzed 67 patients with mandibular fractures 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 fractured subsites were treated. Results: The male-to-female ratio was 1.4:1. Motorcycle accidents were the most common cause of mandibular fractures (72%). Symphysis was the major subsite of fractures (41%), followed by body fractures (n=16, 15.7%) and angle fractures (n=15, 14.7%). In this study, 68.7% of the patients displayed combined fracture, which was defined as multiple mandibular subsites or midface fracture. In this study, 67 (66%) fractured sites among 55 patients were treated by 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. Injury Severity 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%) cases. Conclusion: Motorcycle accident is a major etiology of mandibular fracture in the suburb 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-mm/2.3-mm nonlocking bone plates yielded ideal outcomes.

Key words: Mandibular fracture, Suburb, Motorcycle, Prolonged postoperative stay, Complications.

Taiwan J Oral Maxillofac Surg22: 175-188, September 2011 台灣口外誌

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Taiwan J Oral Maxillofac Surg 台灣口外誌

Introduction

The management of mandibular fracture is

a common practice for Oral and Maxillofacial

Surgeons. Mandibular fracture can occur because

of various causes, such as traffic accidents, falls,

assaults, and sports, and can occur in isolation

or in combination with other injuries. The

epidemiology of these fractures varies depending

on the geographic area, socioeconomic status

of the individual involved, and the period of

investigation1–7. In Western society, the 1970s

involved a documented shift in the mechanism

of injury leading to mandibular fractures7–12.

Specifically, violence and sporting injuries

replaced motor vehicle accidents as the major

cause of mandibular fracture. These trends seem

to hold true for the urban distinct in particular,

whereas rural communities still show a significant

number of fractures incurred during automobile

accidents8–17. In the 1980s, a study of mandibular

fractures in the urban distinct of Taiwan showed

that traffic accidents were still the major cause18.

Different causes of mandibular fracture may be

associated with age and gender, or the site and

severity of the injury.

Data available on the etiology and pattern

of mandibular injuries in this suburb of Taiwan

spurred this hospital-based survey. The results

presented here may assist clinicians and health

care provider in developing more effective

treatments and strategies to prevent these

injuries.

Materials and Methods

Pat i en t s who had t rea ted f o r the i r

mandibular fractures at the Department of Oral

& Maxillofacial Surgery, Chi-Mei Hospital,

Liouying, from February 2009 to December 2010

were retrospectively analyzed. Pathological and

infected fractures were excluded. There were two

major strategies for treating mandibular fractures.

The patients who had high-positioned subcondylar

fracture and condylar fractures were reduced with

three- and one-week rigid intermaxillary fixation

(IMF), respectively (Figure 1). Rubber traction

(elastic IMF) was applied to these patients for

one to two more weeks thereafter. Another

group of patients with symphysis, body and low-

positioned subcondylar fractures were treated

by open reduction and internal fixation by bone

plates. After the surgery, patients postoperatively

underwent elastic IMF for one to two more

weeks (Figure 2 & 3). If the patients displayed

combined midfacial fractures, bottom-up fixation

followed the sequence of lower dental arch

reconstruction, mandibular fixation, rigid IMF,

and midfacial fixation. The surgical reduction and

fixation of mandibular fractures was performed as

soon as possible if the patient presented stable

vital signs and clear consciousness. The surgical

intervention was performed in the following

sequence: the fractured segments were reduced

by the Erich arch bar, any loose teeth were

removed, and bone plate and screw fixation were

performed. Fixation was achieved through the use

of a 2.0-mm non-locking bone plate combined

with a bicortical screws system which was

applied on the lower border of the symphysis and

body fracture and/or by a 1.6-mm miniplate in

combination with monocortical screws, applied on

the modified Champy line (Figure 3). In patients

who did not have open wounds at their fractured

site, the surgical approaches was as intra-

orally as possible. The occlusion was confirmed

before wound closure. Parenteral antibiotics and

a 0.1% chlorhexidine gluconate oral rinse were

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Fig. 1. A case of bilateral condylar neck fracture underwent rigid intermaxillary fixation (A–C). After 1st

week and 3rd month follow up, the condyle head osteogenesis and realign well (D).

B

A

C

1w 3m

D

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prescribed to all patients at the time of surgery,

and their use was continued for 3 to 5 days after

the surgery. After discharge, use of an enteral

antibiotic for 3 to 5 more days was prescribed.

Age, etiology of injury, Injury Severity

Score, site of fracture, type of fracture,

associated midfacial fracture, and treatment were

regarded as independent variables. A comminuted

fracture was defined as three or more fractured

lines. A splitting fracture was defined as more

than 1 cm between two fracture lines. The

affected site was determined by the lowest border

of the fracture line. The dependent variables were

set as the duration of postoperative hospital stay

and major postoperative complications, including

infection, malocclusion, nonunion, dehiscence,

osteomyelitis, and plate exposure.

Follow-up examinations were recorded at

intervals of 1, 2, 4, 6, and 12 weeks after surgery,

with additional examinations if necessary. Patients

with less than 6 weeks of follow-up were excluded

from the study. A 6-week soft diet was advised

for all patients. The Erich arch bars were left in

place postoperatively to facilitate guiding elastics

if necessary and then removed at the 4-week

visit under local anesthesia at the outpatient

clinic. The follow-up variables include interdental

contact checked by articulation paper, maximal

mouth opening checked by inter-incisor distance,

and mandible series or panoramic radiographs

at intervals of 1, 4 and 12 weeks after surgery.

Dental evaluation was performed in patients with

significant carious or periodontal destruction.

Those teeth meeting the following criteria were

Fig. 2. A case of low-positioned, spitting-type subcondylar fracture (A) underwent two lag screws

fixation (B).

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Fig. 3. A case of combined angle fracture (A) and symphysis fracture (B). He underwent surgical fixation

by 2.3 mm bone plate system for symphysis fracture (C) and by 1.3 mm miniplate system for

angle fracture (D). Postoperative 4th week panoramic film revealed bone gap was narrowing (E).

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extracted: (1) teeth with fractured roots (2) teeth

that were unsalvageable as a result of caries or

infection in the region of the fracture; and (3)

teeth within the fracture line that were loose or

unstable. Stable teeth within the fracture line

were preserved for added reduction stability.

The outcome was evaluated at 12th week. The

treatment morbidities are defined if there is

uneven teeth contact, any clinical symptoms

related to surgery, or bone malalignment on X-ray

finding. A statistical analysis using the chi-square

test and Fisher’s exact test was performed to

determine the risk factors for prolonged hospital

stay. The difference was regarded as significance

if any the P value was less than 0.05.

Results

This study included 67 patients (39 males,

28 females) with 102 subsites of mandible

fracture, included 42 symphysis, 16 body, 15

angle, 12 subcondylar, 14 condylar, and 3

alveolar fractures (Figure 4). The mean age

of the patients was 31±16 years (range, 10

to 90 years). The most common etiology was

motorcycle accident (MCA) (72%, n=48), followed

by violence (9%, n=6) and sliding (6%, n=4). Most

of the patients were admitted by the ER (55%,

n=37) followed by trauma team referral (28%,

n=19) and clinic referral (17%, n=11). The median

length of hospital stay was 7 days (range, 2 to 45

days).

Fig. 4. Sixty-seven patients with 102 subsites of mandible fracture. The symphysis fracture combined

with posterior subsite fracture is the most common type of fracture.

Symphysis Body Angle Subcondyle Condyle Alveolus

Multiple sitesn =

27 6 12 10 11 2

Single siten =

16 10 3 2 3 1

Figure 4

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In these 102 subsites of fracture, most

fractures were categorized as greenstick or

simple (54%) followed by comminuted (24%)

and splitting (22%). Thirty-one (65%) of forty-

eight patients traumatized by MCA displayed

symphysis fractures, including 16 simple type,

11 comminuted type, and 4 splitting type. In

55 (82%) patients, 67 fractured sites underwent

open reduction and internal fixation for mandible

fracture, 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. The median length of

the hospital stay after surgery was 5 days (range,

2 to 35 days). Fifteen (27%) patients required a

prolonged postoperative stay (> 5 days). Injury

Severity Score, comminuted/splitting fracture,

and combined midfacial bone fracture displayed

signi f icant associations with a prolonged

postoperative stay (Table 1 & Figure 5).

All 15 angle fracture patients had an

impacted or erupted third molar associated

with the fracture; 13 (87%) patients underwent

impacted third molar extraction during surgery.

Minor occlusal discrepancies responded to elastic

IMF, applied for 1 to 3 weeks. Occlusion was

judged as normal in all patients at the time of

Table 1. The Clinical Parameters associated with Prolonged Postoperative Stay (> 5 days) in 59 Patients

with Mandibular Fracture

Regular Stay Prolonged Stay P value

Age

　　0–30 years 21 (64%) 14 (62%) 0.446

　　> 30 years 12 (36%) 12 (38%)

Gender

　　Male 20 (61%) 16 (62%) 0.920

　　Female 13 (39%) 10 (38%)

Cause of injury

　　Motorcycle 24 (73%) 20 (77%) 0.708

　　Other 9 (27%) 6 (23%)

Injury Severity Score

　　0–15 24 (73%) 10 (39%) 0.008

　　> 15 9 (27%) 16 (61%)

Type of Mandible Fracture

　　Simple 20 (61%) 4 (15%) < 0.001

　　Comminuted/Splitting 13 (39%) 22 (85%)

No. of fractured sites

　　One 24 (73%) 14 (54%) 0.133

　　> One 9 (27%) 12 (46%)

Combined midface fracture

　　No 32 (97%) 19 (73%) 0.017*

　　Yes 1 ( 3%) 7 (27%)

Chi-square test was performed unless otherwise specified.

* Fisher’s exact test.

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Erich arch bars removal.

The median follow-up was 3 months (range,

2 to 22 months). Seven patients displayed

morbidities, and three of the complications were

judged to be iatrogenic. These three patients

displayed screws loosening and orocutaneous

fistula over the previous comminuted body

fracture site approximately one to two weeks after

surgery. Their symptoms and signs disappeared

after re-entry to remove the sequestrum and to

re-fix the bone segments using a stronger bone

plate. The symptoms and signs subsided after the

re-entry to remove hardware with or without re-

fixation with a stronger plate and maintenance of

rigid IMF for 4 more weeks.

Discussions

The treatment of mandibular fractures has

changed significantly in the past century. The

use of a Barton bandage or a Gunning splint has

evolved to the use of IMF alone, IMF plus open

reduction with intrabony stainless-steel wire

fixation, and IMF with open reduction using bone

plates and screws. Multiple plate application

techniques have been proposed in the past 30

years for the treatment of mandibular fractures.

The lower-border plating techniques proposed

by AO/ASIF and Luhr have demonstrated

reproducible results19–21. Their approach is based

on the concept that the largest plate can provide

the greatest interfragmental stability. In contrast,

Michelet and Champy advocated the use of

the small plates. This approach evolved from a

surgical approach based on skin incision to one

based on intraoral access because of the use of a

relatively small size plate22.

The etiology of the trauma determined

17

62

3

Complicated mandible fracture

Midface fracture

Complications

Regular Stay Simple mandible fracture

00

1

15

21

62

3

Complicated mandible fracture

2

Midface fracture

Complications

Prolonged StaySimple mandible fracture

34

3

Figure 5

Fig. 5. Compared with the group of regular post-operative stay, the group of prolonged (> 5 days) post-

operative stay present more complicated mandibular fracture, midface fracture and complications.

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the site of the fracture. Because of the high

prevalence of violence in Western society, the

closed-type angle fracture is the most common

type of mandibular fracture8–17. The mandibular

angle is subject to the forces related to

masticator and suprahyoid musculature resulting

in unstable rotation of the proximal and distal

fracture segments23. An impacted third molar

tooth may complicate the angle fracture, even

resulting in the abatement of bone contact and

compromising ideal interfragmental reduction24,

25. Unlike people living in urban areas, who have

access to a well-established Mass Rapid Transit8-

18, people living in suburban Taiwan typically

commute by motorcycle. In a crash, the anterior

facial bones will be severely traumatized not

only because of the poor quality of the road but

also because of the lack of law-abidance among

motorcyclists. Several studies have indicated that

the mandibular body is the most common subsite

affected by an MCA26–29. Our study revealed

that among individuals living in this surban

distinct, the symphysis was the subsite most

commonly affected by motorcycle injury. We used

occlusal film to evaluate the anterior mandible

if the patient presented a condylar trauma; this

approach allows visualization of fracture line in

the symphyseal region that cannot be seen using

plain film or panoramic film (Figure 3).

Despite the compressive, tensile, and

torsional forces around the symphysis region,

the advancement of bone plate and screw

fixation and the easy intra-orally approach

have facilitated treatment. Angle fracture can

usually be reduced by rigid IMF for 4 to 6 weeks

because of vital structures around the surgical

field. Poor oral hygiene, a malaligned dental arch,

and missing teeth are not uncommon among

Taiwanese; therefore, IMF is difficult and may

precipitate other complications related to oral

hygiene maintenance, risk of infection traveling

along the gingival sulcus to the fractured site,

and short-term limited mouth opening. Indirect

interfragmental reduction assisted by IMF may

not yield proper reduction and may increase

the width of the lower face30. Although the rigid

fixation has been shown to decrease or eliminate

IMF time, the complication rates were still not

low compared with other subsites because of

the difficulty of plate manipulation at the lower

border. Champy and Kahn proposed intraoral

placement of monocortical screws and miniplates

along the ideal lines of osteosynthesis, which

would theoretically neutralize undesirable tensile

forces and retain favorable compressive forces

during function22, 31. Unlike the concept of rigid

fixation, this nonrigid technique of fixation could

be defined as functionally stable fixation32, 33.

Some advantages of miniplate osteosynthesis

by an intraoral approach over other means of

rigid fixation include eliminating the risk of a

large hypertrophic cutaneous scar, eliminating

the risk of damaging the marginal branch of the

facial nerve, and the capacity for simultaneous

observation of fracture line reduction and occlusal

relationships. In addition, miniplates are less

palpable externally and less thermally sensitive

to the patient. Although there are various

techniques available for upper-border plating,

single miniplate insertion would give consideration

to economize the treatment cost and eliminate

“ fore ign body sensat ion” in pat ients 34.

Although providing functionally stable fixation,

noncompression of the fracture using miniplates

decreases necrosis of the fracture segments and

causes less stress shielding. Because there is less

resistance to torsional movements, miniplates are

not recommended for comminuted and infected

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fractures, where a rigid fixation plate system that

prevents micromotion of body fragments under

function is desired.

The 4.5% complication rate of our study

population was not unfavorable compared with

previous studies (Table 2). Noncompliance was

manifested in the patients with poor oral hygiene,

poor oral intake, smoking, and early self-removal

of the IMF. Seemingly, it was only the latter that

resulted in infection in the present group. The

other three patients displayed infection at the

site of the comminuted fracture after the surgery.

These complications were treated with another

course of antibiotics, prolonged rigid IMF, use of

a stronger plate, and enhanced oral hygiene. The

stability of the 2.0-mm bone plate system used to

treat mandibular fractures might make it possible

to shorten the 4-week period of rigid IMF to

2-week elastic IMF while maintaining acceptable

complication rates. However, in the study done

by Ellis and Graham, in which 80 fractures in

59 patients were treated with 102 plates using

a locking plate and screw system without any

period of IMF, there were 12 complications (15%);

6 infections, 2 malocclusions, and 4 instances of

hardware removal35. We believe combined 2-week

elastic IMF is needed with transoral mandibular

fracture fixation because this would allow

reattachment of the soft tissue drape, stabilize

the occlusion, and thus decrease the incidence

of complication. We believe this period of elastic

IMF helped to decrease the rate of complications

associated with the use of a nonlocking system.

We highly recommend this intraoral technique.

Table 2. Profile of the Patients presenting Major Surgical Complications

Age No. of cases

Subsites and Type of fracture

Primary treatment Complication rate

Singh36 et al

16–52 76 Symphysis 21%, Body 38.4%, Angle 34.2%, Condyle 7.9%

2.0-mm locking plate,2.0-mm nonlocking plate

Symphysis 18.8% Body 3.6%

Angle 11.5%

Mathog37 et al

27–45 906 Symphysis 17.6%, Body 17.6%, Angle 27.7%, Ramus 10.3%, Condyle 19.6%

ORIF with bone plate, IMF only,

External fixation, ORIF with wire

2.8%

Furr38 et al

14–68 271 NM ORIF, IMF only, IMF & ORIF

6.6%

Ellis39 et al

12–60 196 Symphysis 24.9%, Body 50.3%, Angle 15.7%, Ramus 9.1%,

Comminuted type

2.7-mm reconstruction locking plate,

2.3-mm bone plate, 2.0-mm miniplate

13%

ORIF, open reduction with internal fixation. NM, no mention. IMF, intermaxillary fixation.

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Conclusions

Because complicated mandible fractures are

common type of facial trauma in this suburban

distinct, we should not ignore the major

contributory factor of motorcycle accidents and

should force government to make improvement

strategies. The duration of postoperative stay

must be evaluated in consideration of associated

injuries and the type of fracture. In our study, use

of the rigid 2.0-mm and 2.3-mm nonlocking bone

plate system for anterior mandibular fractures and

of the 1.6-mm miniplate system along a modified

Champy’s line for angle fracture plus two-week

elastic IMF represent reliable treatments for

mandibular fractures.

References

1. Iida S, Kogo M, Sugiura T, et al. Retrospec-

tive analysis of 1502 patients with facial

fractures. Int J Oral Maxillofac Surg 2001;

30: 286–90.

2. Kadkhodaie MH. Three-year review of facial

fractures at a teaching hospital in northern

Iran. Br J Oral Maxillofac Surg 2006; 44:

229–31.

3. Sakr K, Farag IA, Zeitoun IM. Review of 509

mandibular fractures treated at the University

Hospital, Alexandria, Egypt. Br J Oral

Maxillofac Surg 2006; 44: 107–11.

4. Cheema SA, Amin F. Incidence and causes

of maxillofacial skeletal injuries at the Mayo

Hospital in Lahore, Pakistan. Br J Oral

Maxillofac Surg 2006; 44: 232–4.

5. Brasileiro BF, Passeri LA. Epidemiological

analysis of maxillofacial fractures in Brazil:

A 5-year prospective study. Oral Surg Oral

Med Oral Pathol Oral Radiol Endod 2006;

102: 28–34.

6. Bakardjiev A, Pechalova P. Maxillofacial

fractures in Southern Bulgaria—A retrospec-

tive study of 1706 cases. J Craniomaxillofac

Surg 2007; 35: 147–50.

7. Erdmann D, Follmar KE, DeBruijn M, et al.

A retrospective analysis of facial fracture

etiologies. Ann Plast Surg 2008; 60: 398–403.

8. van Beek GJ, Merkx CA. Changes in the

pattern of fractures of the maxillofacial

skeleton. Int J Oral Maxillofac Surg 1999; 28:

424–8.

9. Bus io to MJ , Sm i th DJ , Robson MC.

Mandibular fractures in an urban trauma

center. J Trauma 1986; 26: 826–9.

10. Azevedo AB, Trent RB, Ellis A. Population

based analysis of 10766 hospitalizations for

mandibular fractures in California. J Trauma

1998; 45: 1084–7.

11. Sojot AJ, Meisami T, Sandor GK, et al. The

epidemiology of mandibular fractures treated

at the Toronto general hospital: A review

of 246 cases. J Can Dental Assoc 2001; 67:

640–4.

12. Gassner R, Tuli T, H.achl OH, Rudisch A,

Ulmer H. Cranio-maxillofacial trauma: A

10 year review of 9543 cases with 21 067

injuries. J Craniomaxillofac Surg 2003; 31:

51–61.

13. Carlin CB, Ruff G, Mansfield CP, et al. Facial

Fractures and related injuries: A ten year

retrospective analysis. J Craniomaxillofac

Trauma 1998; 4: 44–8.

14. Fridrich K, Pena-Velasco G, Olson R.

Changing trends with mandibular fractures: A

review of 1067 cases. J Oral Maxillofac Surg

1992; 50: 586–9.

15. Olson R, Fonseca R, Zeitler D, et al.

Fractures of the mandible: A review of 580

- 186 -


cases. J Oral Maxillofac Surg 1982; 40: 23–8.

16. Scherer M, Sullivan W, Smith D, et al.

An analysis of 1423 facial fractures in 788

patients at an urban trauma center. J Trauma

1989; 29: 388–90.

17. Haug R, Prather J , Indresano T. An

epidemiologic survey of facial fractures and

concomitant injuries. J Oral Maxillofac Surg

1990; 48: 635–8.

18. Lin SC, Hahn LJ. Clinical study of mandibular

fractures. Chin Dent J 1982; 1: 57–63.

19. Luhr HG, Hausmann DF. Resu l t s o f

compression osteosynthesis with intraoral

approach in 922 mandibular fractures.

Fortschr Kiefer Gesichtschir 1996;41: 77–80.

20. Niederdellmann H, Schilli WG. Functionary

stable osteosynthesis in the mandible. Dtsch

Zahnarztl. Z 1972; 27: 138–42.

21. Kushner GM, Alpert B. Open reduction and

internal fixation of acute mandibular fractures

in adults. Facial Plast Surg 1998; 14: 11–21.

22. Champy M, Pape H-D, Gerlach KL, Lodde

JP. The Strasbourg miniplate osteosynthesis

in oral and maxillofacial traumatology.

Krüger E, Schilli W, editors. Quintessence

Publishing, Chicago: Vol. II 1986.

23. Rudderman RH, Mullen RI, Philips JH.

The biophysics of mandibular fractures:

an evolution toward understanding. Plast

Reconstr Surg 2008;121:596–607.

24. El l is E I I I , Walker LR. Treatment of

mandibular angle fractures using one noncom-

pression miniplate. J Oral Maxillofac Surg

1996; 54: 864–71.

25. Feller KU, Schneider M, Hlawitschka M, et

al. Analysis of complications in fractures of

the mandibular angle—A study with finite

element computation and evaluation of data of

277 patients. J Cranio Maxillofac Surg 2003;

31: 290–5.

26. Ramli R, Abdul Rahman R, Abdul Rahman N,

Abdul Karim F, Krsna Rajandram R, Mohamad

MS, et al. Pattern of maxillofacial injuries in

motorcyclists in Malaysia. J Craniofac Surg

2008;19:316–21.

27. Oginni FO, Ugboko VI, Ogundipe O,

Adegbehingbe BO. Motorcycle-related

maxillofacial injuries among Nigerian intracity

road users J Oral Maxillofac Surg 2006; 64:

56–62.

28. Tsai CC, Cheng LH, Lu TH. Maxillofacial

Fractures - A Review of 417 Cases. J Taiwan

Otolarygology-Head and Neck Surg 1999; 34:

298–303.

29. S ir imahara j W, Pyungtanasup K. The

epidemiology of mandibular fractures treated

at Chiang Mai University Hospital: a review

of 198 cases. J Assoc Thai Med 2008; 91:

868–74.

30. Gerbino G, Boffano P, Bosco GF. Symphyseal

mandibular f ractures associated with

bicondylar fractures: a retrospective analysis.

J Oral Maxillofac Surg 2009; 67: 1656–60.

31. Champy M, Loddé JP, Schmitt R, Jaeger

JH, Muster D. Mandibular osteosynthesis

by miniature screwed plates via a buccal

approach. J Maxillofac Surg 1978; 6: 14–21.

32. Ellis E III. Treatment methods for the

fractures of mandibular angle. Int J Oral

Maxillfac Surg 1999; 28: 243–52.

33. Ellis E III. A prospective study of 3 treatment

methods for isolated fractures of the

mandibular angle. J Oral Maxillofac Surg.

2010; 68: 2743-54

34. Mehta P, Murad H. Internal fixation of

mandibular angle fractures: A comparison of 2

techniques. J Oral Maxillofac Surg 2008; 66:

2254–60.

- 187 -


35. Ellis E III, Graham J. Use of a 2.0 mm locking

plate/screw system for mandibular fracture

surgery. J Oral Maxillofac Surg 2002; 60:

642–5

36. Singh V, Kumar I, Bhagol A. Comparative

evaluation of 2.0-mm locking plate system

vs 2.0-mm nonlocking plate system for

mandibular fracture: a prospective randomized

study. Int J Oral Maxillofac Surg 2011; 40:

372–7.

37. Mathog RH, Toma V, Clayman L, Wolf S.

Nonunion of the mandible: an analysis of

contributing factors. J Oral Maxillofac Surg

2000; 58: 746-52.

38. Furr AM, Schweinfurth JM, May WL. Factors

associated with long-term complications after

repair of mandibular fractures. Laryngoscope

2006; 116: 427–30.

39. Ellis E III, Muniz O, Anand K. Treatment

considerations for comminuted mandibular

fractures. J Oral Maxillofac Surg 2003; 61:

861–70.

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Received: May 30, 2011Accepted: July 15, 2011Reprint requests to: Dr. Wei-Fan Chiang, Chi-Mei Medical Center, Liouying. 201, Taikang Village,

Liouying Dist., Tainan 736, Taiwan. E-mail: [email protected]

鄉村區醫院之下顎骨折表現─兩年期

病例回溯分析

鄭智文1　楊榮武2　林哲毅2　張敏德2　陳俊榮2　蔣維凡2,3

1柳營奇美醫院牙醫部

2永康奇美醫院牙醫部

3國立陽明大學牙醫系

摘　　要

目的：台灣地區下顎骨骨折的成因、型態、手術治療與相關預後，甚少在

文獻被提出，甚至以鄉村地區為背景進行的研究更是付之闕如。本文針對一

所鄉村區醫院之病例進行分析，除了有利臨床醫師暸解鄉村區之下顎骨骨折

病例表現特色與相關治療成果，也提供公共衛生學家進行相關政策制定之參

考。病患與方法：本研究針對2009年至2010年間在柳營奇美醫院口腔顎面外

科治療之67名病患共102處下顎骨骨折點進行回溯性分析，所有病患之治療皆

遵從固定之準則，並在單一醫師指導下進行。結果：男女比為1.4比1，下顎

骨骨折之主要成因為摩托車事故(72%)，發生部位以正中聯合區最多(41%)，

其次依序為體區(15.7%)、角區(14.7%)。68.7%病患為多處下顎骨骨折或是合

併中顏面骨骨折之複合式骨折。共有55位病患的67處骨折位接受開放式復位

及內固定之手術，其中包括：21處以1.6 mm迷你骨板固定、36處以2.0

mm系統

骨板固定、9處以2.3 mm系統骨板固定、1處以lag

screw進行固定。手術後超

時住院(超過5日)之相關因子有：外傷嚴重指數、複雜形態之骨折、合併中顏

面骨骨折等等因素，醫源相關性之併發症共有3例(4.5%)。結論：摩托車交通

意外為鄉村區下顎骨骨折之主要因素並且造成較高分數之外傷嚴重指數。術

後超時住院與否必須端賴身體其他外傷情形與下顎骨折之型態來決定。本院

以1.6 mm迷你骨釘骨板和2.0

mm骨釘骨板針對不同部位之下顎骨骨折進行手術

治療，相關成果尚稱理想，值得參考運用。

關鍵詞：下顎骨骨折，鄉村，摩托車，術後超時住院，併發症。

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