Analysis of 115 Mandibular Angle Fractures

doi:10.1016/j.joms.2007.05.025

Journal of Oral and Maxillofacial Surgery

Volume 66, Issue 1, January 2008, Pages 73-76

https://doi.org/10.1016/j.joms.2007.05.025 Get rights and content

Purpose

This retrospective study reviewed cases of fractures of the mandibular angle to identify personal data, social traits, fracture characteristics, treatment modalities, and postoperative complications.

Patients and Methods

From April 1999 until July 2004, 114 patients were treated for 115 fractures of the mandibular angle by the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School-Unicamp, in Brazil.

Results

More angle fractures were observed in Caucasian (55%) men (89%) with some kind of drug addiction (62%). Patient mean age was 27 years. The majority of fractures in this study were sustained in altercations, including gunshot wounds (43%), followed by vehicle accidents, including bicycles and being struck by a car (39%). Open fractures were the most frequent (90%), with prevalence of the left side (57%). Only 1 patient sustained bilateral angle fractures. Ninety-seven patients (85%) underwent open reduction. Complications occurred in 19 patients (17%); 10 (9%) were infections. Of the total number of complications, 3 underwent another surgical intervention for refixation. The factors that contributed to the development of postoperative complications were social risks that included alcohol abuse, smoking, and intravenous and nonintravenous drug abuse.

Conclusions

Angle fracture management outcomes are affected by many factors beyond method of fixation.

Section snippets

Patients and Methods

Information was obtained retrospectively from clinical notes, surgical records, and radiographs. From April 1999 until July 2004, 114 patients were treated for 115 fractures of the mandibular angle by the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School, State University of Campinas-Unicamp, São Paulo, Brazil. The data recorded included patient gender, age, etiology, method of surgical treatment, drug use, and short-term complications. The radiographs were evaluated with

Results

A higher prevalence of trauma was observed in Caucasian (55%) men (89%). The patients’ mean age was 27 years (range, 16 to 62 years), with some type of drug addiction (alcohol, intravenous, and nonintravenous drugs) (62%), and dentate (52%). The majority of fractures in this study were sustained in altercations (39%), followed by motor vehicle accidents (27%). Patient demographic data are shown in Table 1. No relevant medical history affecting bone healing, notably diabetes, prolonged steroid

Discussion

Fractures of the mandibular angle account for the highest percentage of mandibular fractures in many studies. The angle of the mandible is associated commonly with fractures, for several proposed reasons, including the presence of the third molar. Consistent with Ugboko et al²⁰ and differing from other studies,8, 21, 22, 23, 24 the results of this study did not confirm an increased risk of angle fractures when the mandibular third molar was present (55%); patients reported the extraction of

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Cited by (51)

Comparison of Conventional Versus Right Angled Fixation Technique in Management of Mandibular Angle Fractures – A Prospective Randomized Clinical Study
2023, Journal of Oral and Maxillofacial Surgery
The treatment of mandibular angle fractures ranges from observation to closed reduction with maxillomandibular fixation to open reduction and internal fixation. The study aims to compare the effectiveness of three different techniques (transoral, transbuccal, and right-angled fixation technique) for single adaptational monocortical upper border plating in mandibular angle fracture.
The study conducted at our center was a prospective randomized study. The study duration was from November 2019 to August 2021. The three groups included in our study were transoral, transbuccal, and transoral approach using the right-angled drill. Patients who required open reduction and internal fixation of mandibular angle fracture were included in the study. Computer-generated randomization method was used to assign the participants among the 3 groups, ie, transoral, transbuccal, or right-angled fixation technique. The primary outcome clinical variables were mouth opening (MO), occlusion stability, scar or laceration, facial nerve weakness, infection, and the radiological variables were gap between the fracture segments and displacement of the fracture segment. The secondary outcome of our study is a comparison of the perioperative complications including plate exposure during the entire fracture healing period. The covariates of the study were age, sex, etiology, and tooth in line of fracture. Statistical analysis was done using ANOVA, post hoc Tukey test, and Pearson χ² test. A P value less than 0.05 was considered statistically significant.
A total of 48 patients were included in our study. According to randomization, each group was allotted 16 patients. In the study, 66.7% of the study population were male and 33.3% were female; 75% of the study population were victims of road traffic accidents, and 25% were injured due to assault. The mean and standard deviation for MO at 1 month were 31.3 ± 2.9 for the transoral group, 35.8 ± 1.7 for the transbuccal group, and 35.5 ± 1.3 for the right-angled fixation group. On intergroup comparison, statistically significant results were seen at the 1-month postoperative MO clinical parameter. The P value here was 0.02 which was statistically significant.
The comparison of the right-angled fixation technique to transoral and transbuccal fixation methods have not been documented. Our study is the first of its kind to compare the right-angled fixation technique to various other approaches. Our study showed that the MO was better postoperatively with the transbuccal approach. The other variables showed no difference among the three techniques.
Blunt force trauma in the human mandible: An experimental investigation
2022, Forensic Science International: Reports
There exist sparse data associating known points of mandibular impact with resultant fracture patterns. These data may provide an important foundation for interpreting mandible fractures in forensic cases. The current study illustrates results of experimental blunt force impacts to five locations on the mandible: the ramus, posterior body, mid-body, anterior body, and midline. The experimental sample comprised thirteen intact heads from non-edentulous, unembalmed human adult male cadavers. Three key findings resulted from this study: (1) each impact produced a fracture at or adjacent to the impact site; (2) ramus and midline impacts produced more fractures than mandibular body impacts; and (3) fracture locations varied among mandibles impacted at the same location and exhibited similarities among mandibles impacted at different locations, suggesting there are limitations in estimating mandibular impact sites based on fracture location alone. Overall, these results contribute a comparative sample of known blunt force trauma cases for practitioners evaluating mandibular fractures in forensic cases.
Surgical Management of Mandibular Angle Fractures: Does the Extraction of the Third Molar Lead to a Change in the Fixation Pattern? A European Multicenter Survey
2021, Journal of Oral and Maxillofacial Surgery
The authors conducted a retrospective, multicenter study to investigate the differences in the fixation patterns, in terms of number and thickness of plates, between patients in whom a third molar (3M) was maintained or removed in the line of mandibular angle fractures.
The study was conducted in 6 European level I and II maxillofacial trauma centers. Data were collected on patients ≥ 16 years of age who underwent open reduction internal fixation (ORIF) for mandibular angle fractures (MAF) from 2008 to 2018, in whom a 3M in the fracture line was present and who had a follow-up duration of 6 months. The study population was divided into 2 groups: patients treated with ORIF in whom the 3M was maintained (group 1) and those treated with ORIF in whom the 3M was extracted (group 2) during treatment. The 2 groups were compared for differences in the internal fixation pattern, specifically in terms of the number and thickness of the plates.
A total of 749 patients with 774 MAF were collected. A total of 1,050 plates were placed: 849 were ≤ 1.4 mm thick (80.9%) and 201 plates ≥ 1.5 mm thick (19.1%). 548 patients were treated with ORIF and 3M maintained (group 1), and 201 treated with ORIF and 3M extracted (group 2). Statistically significant differences were seen in the number of ≤1.4 mm plates between the 2 groups for single undisplaced/displaced MAF(P value ≤ 0.5) and for undisplaced/displaced angle + parasymphysis/body fractures (P-value ≤ 0.5).
Analyses of data collected from 6 European maxillofacial centers indicated that the majority of surgeons of our sample perceived the MAF as being more unstable when removing the 3M during ORIF leading them to perform a rigid fixation in the angular region.
Surgical Management of Bilateral Mandibular Angle Fractures With a Third Molar in Line of Fracture: A European Multicenter Survey
2021, Journal of Oral and Maxillofacial Surgery
The aim of this survey was to investigate the surgical management of bilateral mandibular angle fracture (BMAF) in Europe.
Data were collected from 2008 to 2018 on patients ≥ 16 years of age who underwent open reduction internal fixation (ORIF) for BMAF with a third molar in the fracture line. The study was conducted at 6 European trauma centers. The following data were recorded: sex, age, cause of the fracture, type of fracture (nondisplaced, displaced, comminuted), type of approach (intraoral, transbuccal, or extraoral), thickness of the plate (≤1.4 mm or ≥1.5 mm), number of plates, cause of plate removal, and third molar extraction status.
25 patients with BMAF (24 males, 1 female, 17 to 83 years old [mean: 28.2 years]) were collected. The main cause of BMAF was assault, and the main surgical approach was intraoral. The most common types of BMAF were displaced + undisplaced (11 patients), displaced + displaced (7 patients), undisplaced + undisplaced (6 patients), and comminuted + comminuted (1 patient). Osteosynthesis was performed with 2 ≤1.4 mm plates on 1 angular fracture and 1 ≤1.4 mm plate on the other fracture in 11 patients, 1 ≤1.4 mm plate on both angular fractures in 6 patients, 1 ≥1.5 mm plate on both fractures in 5 patients, and 2 ≤1.4 mm plates on both fractures in the remaining 3 patients. Out of 25 patients with BMAF, 7 third molars were extracted during ORIF. Among these patients, angular fracture fixation was performed in 3 cases with 1 ≥1.5 mm plate and in 4 patients with 2 ≤1.4 mm plates.
This retrospective multicenter survey indicates a trend of treating with open reduction and rigid internal fixation at least 1 angular fracture of BMAF and those cases requiring extraction of the third molar in the line of fracture.
The Influence of Mandibular Gonial Angle on Fracture Site
2020, Journal of Oral and Maxillofacial Surgery
The mandibular angle is influenced by multiple codependent morphologic dynamic factors, such as osseous anatomy, forces exerted by the muscles of mastication, occlusal loading patterns, and anatomic structures. These factors can influence the presence of a fracture in this area. Our research aimed to investigate a potential correlation between the risk of angle fractures and age, gender, fracture etiology, gonial angle size, presence of mandibular third molars, or presence of occlusal support.
This retrospective cohort study was composed of patients treated for mandibular fractures between 2007 and 2018. The primary predictor variable was the gonial angle, and the primary outcome variable was the fracture site. Other study variables included demographic data, fracture etiology, third molar status, and presence of occlusal support. Appropriate univariate, bivariate, and multivariate statistics were applied, and statistical significance was set at P < .05.
Of 332 isolated mandibular fractures included, 109 were angle fractures; 165, condylar; and 58, body or symphysis. The mean age of patients with angle fractures was 25.5 years, compared with 31.3 years and 32.7 years for those with condylar fractures and body or symphysis fractures, respectively. The mean gonial angle was 125.4° in patients with angle fractures compared with 120.9° and 120.2° in those with condylar fractures and body or symphysis fractures, respectively. The variables that were found predictive of angle fractures were a wider gonial angle and the presence of third molars.
Third molars and the gonial angle are predictors of the location of mandibular fractures. Wide gonial angles and the presence of third molars are predictors of mandibular angle fractures.
Evidence-Based Medicine in Facial Trauma
2017, Facial Plastic Surgery Clinics of North America

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Basic and patient-oriented researchAnalysis of 115 Mandibular Angle Fractures

Purpose

Patients and Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Discussion

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Basic and patient-oriented research
Analysis of 115 Mandibular Angle Fractures