Mandible Fracture in Sawanpracharak Hospital

Abstract

Background: Maxillofacial injury was one of major injuries in Sawanpracharak Hospital. Mandible is dynamic facial bone for chewing and biting which is an important function to be restored. Mandible fracture could be managed by different methods: conservative and symptomatic treatment, closed reduction and intermaxillary fixation, open reduction and internal fixation by interosseous wiring or rigid fixation with plate and screw which was used by many surgeons combination with intermaxillary fixation, then advantage of using it was less value.

Objectives: To study epidemiology, surgical technique and cost benefit of alternative internal fixation methods of mandible fracture patients in Sawanpracharak Hospital.

Patients and methods: Retrospective review from medical record of 398 mandible fracture in-patients in Sawanpracharak Hospital during May 2007 - December 2009. 145 patients were managed by the author.

Result: The most common cause of maxillofacial injured patients was road traffic accident and motorcycle was a majority vehicle, males and aged of 10 – 30 years were majority group, 1,095 (70.4%) patients had combined soft tissue injuries and incidence of mandible fracture was 25.6%. The most common affected region was symphysis: 236 (44.6%). There were 136 (34.2%) cases who had one more contra lateral fracture side. 88 (22.1%) patients had combined facial bone fracture that maxilla was predominate. Internal fixation with interosseous wiring and intermaxillary fixation was the author’s preferable technique: 90 (62.1%) cases. The total medical care cost of mandible fracture was 27,947.75 baht per patient and the cost of plates/screws and wire were 4,531.98 and 452 baht per patient respectively. There were 8 (6.7%) cases of wound infection which were responded to antibiotic treatment but one case contributed to chronic osteomyelitis and non-union which was successfully reconstructed by iliac crest bone graft.

Conclusion: The mandible fracture was one of most common maxillofacial injuries and motorcycle accident was a major cause which might be prevented by wearing helmet. It could be effectively treated by interosseous wiring and intermaxillary fixation that the cost was cheaper than plate and screw which should be performed in patients of simple, vertical fracture without suffering from 6 weeks of intermaxillay fixation.