Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Diagnosis of split fractures of the mandible in adults

  • Taesik Kim (Department of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center , Eulji University College of Medicine) ;
  • Sung Gyun Jung (Department of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center , Eulji University College of Medicine) ;
  • In Pyo Hong (Department of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center , Eulji University College of Medicine) ;
  • Young Joong Hwang (Department of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center , Eulji University College of Medicine)
  • Received : 2023.06.08
  • Accepted : 2023.08.09
  • Published : 2023.08.20
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Abstract

Background: Mandibular split fractures, in which the fracture occurs exclusively in the posterior wall, are uncommon. This study aimed to enhance clinicians' understanding of mandibular split fractures and offer insights for future research. Methods: This study included six patients who visited our hospital between January 2020 and June 2023 and were diagnosed with mandibular split fractures. We retrospectively collected data from patients' medical records on their age, sex, symptoms, mechanism, impact site, associated injuries, and treatment method, as well as the location, pattern, and number of fractures observed on computed tomography (CT) and panoramic images. The frequency of split fractures among all mandibular fractures was calculated. Results: The six patients included three men (50%) and three women (50%), ranging in age from 20 to 71 years (mean age, 49.8 years). The split fractures were located in the symphysis in one patient (16.7%), symphysis to parasymphysis in two patients (33.3%), parasymphysis in one patient (16.7%), and parasymphysis to the body in two patients (33.3%). Four patients (66.7%) had condylar head fractures, while two patients (33.3%) had single split fractures. The mechanism of trauma was a slip-down incident in four cases (66.7%), while two cases (33.3%) were caused by motorcycle traffic accidents. Four patients (67%) underwent intermaxillary fixation, while two patients (33%) improved with conservative treatment. Split fractures were diagnosed in all six patients on CT, whereas the fracture line was not clearly visible on panoramic images. Mandibular split fractures accounted for 5.6% of all mandibular fractures. Conclusion: This study provides insights into the clinical characteristics of rare mandibular split fractures and the diagnostic imaging findings. Furthermore, CT scans and three-dimensional image synthesis-instead of panoramic images-may be essential for accurately diagnosing mandibular fractures, including mandibular split fractures, in the future.

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References

  1. Dell' Aversana Orabona G, Iaconetta G, Abbate V, Califano L. Bifocal mandibular fractures: which should be treated first? J Craniofac Surg 2012;23:1723-7.  https://doi.org/10.1097/SCS.0b013e31826bf24d
  2. Nair MK, Nair UP. Imaging of mandibular trauma: ROC analysis. Acad Emerg Med 2001;8:689-95.  https://doi.org/10.1111/j.1553-2712.2001.tb00186.x
  3. Pickrell BB, Serebrakian AT, Maricevich RS. Mandible fractures. Semin Plast Surg 2017;31:100-7.  https://doi.org/10.1055/s-0037-1601374
  4. Prasad KC, Prasad SC, Shenoy SV, Kumar A. Management of head and neck trauma in a developing country. Indian J Otolaryngol Head Neck Surg 2009;61(Suppl 1):35-43.  https://doi.org/10.1007/s12070-009-0015-7
  5. Ogunmuyiwa SA, Fatusi OA, Ugboko VI, Ayoola OO, Maaji SM. The validity of ultrasonography in the diagnosis of zygomaticomaxillary complex fractures. Int J Oral Maxillofac Surg 2012;41:500-5.  https://doi.org/10.1016/j.ijom.2012.01.002
  6. Sever C, Kulahci Y, Uygur F, Karagoz H. Unusual split fracture of the mandible. J Craniofac Surg 2011;22:e10-1.  https://doi.org/10.1097/SCS.0b013e31822ec7b6
  7. Ersan N, Ilguy M. Diagnosis of unusual mandibular split fracture with cone-beam computed tomography. J Oral Maxillofac Radiol 2015;3:67-9.  https://doi.org/10.4103/2321-3841.157528
  8. Jung S, Yun H, Chung CH, Kim K, Chang Y. A computed tomography-based analysis of the structure of the mandible according to age and sex. Arch Craniofac Surg 2022;23:103-10.  https://doi.org/10.7181/acfs.2022.00150
  9. Kim YG, Yoon SH, Oh JW, Kim DH, Lee KC. Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience. Arch Craniofac Surg 2022;23:23-8.  https://doi.org/10.7181/acfs.2021.00549
  10. Lee CY, Kim CH. A vertically split fracture of the marginal tubercle of the zygoma in a 3-year-old boy: a case report. Arch Craniofac Surg 2022;23:274-7.  https://doi.org/10.7181/acfs.2022.00906
  11. Wilson IF, Lokeh A, Benjamin CI, Hilger PA, Hamlar DD, Ondrey FG, et al. Prospective comparison of panoramic tomography (zonography) and helical computed tomography in the diagnosis and operative management of mandibular fractures. Plast Reconstr Surg 2001;107:1369-75.  https://doi.org/10.1097/00006534-200105000-00008
  12. Naeem A, Gemal H, Reed D. Imaging in traumatic mandibular fractures. Quant Imaging Med Surg 2017;7:469-79.  https://doi.org/10.21037/qims.2017.08.06
  13. Roth FS, Kokoska MS, Awwad EE, Martin DS, Olson GT, Hollier LH, et al. The identification of mandible fractures by helical computed tomography and panorex tomography. J Craniofac Surg 2005;16:394-9.  https://doi.org/10.1097/01.scs.0000171964.01616.a8