2021, Number 1
Analysis of fractures of the lower third of the face at the Balbuena General Hospital during the period 2017-2019
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ABSTRACT
Introduction: The present study aims to assess the prevalence, etiology, and fracture sites, regarding age, gender, and state most affected in the Maxillofacial Surgery Service of the General Hospital of Balbuena of the Secretary of Health, Mexico City, Mexico. Material and methods: A retrospective review, from January 1, 2017 to February 28, 2019, of the files and imaging studies of patients attending in the Maxillofacial Surgery Service and show a fracture in the mandibular region. Results: 674 patients with trauma to the maxillofacial region were treated, of which 184 patients (167 male and 17 female) presented some kind of mandibular fracture, of which. Conclusion: The Balbuena General Hospital is a hospital with a high concentration of facial trauma, in which we can see a high incidence of facial fractures, hence the importance of this study to determine the incidence of mandibular fractures in our service.INTRODUCTION
Mandibular fractures after nasal fractures are the most common in maxillofacial trauma because the mandible is the largest and most prominent bone in the face. Previous studies have reported that mandibular fractures are the most common facial injuries, treated by oral and maxillofacial surgeon.1,2 The weak site of the mandible that most easily can fracture includes the jaw's angle, precisely when related to an erupted third molar.3-5
For some authors,6 the mandible is the bone most frequently fractured in blunt trauma. Because the mandible follows the rule of circular bones, that is, when they are fractured, they do so in more than one place, which is why a loss of continuity is observed; a second associated fracture must be ruled out.7,8 The two main causes of this injury appear to be assaults with violence (34-53.5%) and automobile accidents (46-48%).9
The most common fracture varies depending on the country studied, but mandibular angle fractures and those of the condylar region are more frequent, regardless of the country reported.10 Generally, a trauma in extra or intraoral soft tissue such as erosions, contusions, lacerations, and avulsions, which in turn can be accompanied by hemorrhage, trismus, dental mobility, and bone fragments, accompanied these fractures.11,12
The present study aims to assess the prevalence, etiology, and fracture sites regarding age, gender, and state most affected in the Maxillofacial Surgery Service of the General Hospital of Balbuena of the Secretary of Health, Mexico City, Mexico.
MATERIAL AND METHODS
The present report is a descriptive, retrospective study carried out in the Maxillofacial Surgery Service of the General Hospital of Balbuena of the Secretary of Health, Mexico City, Mexico. For this purpose, the medical files and imaging studies of patients attending the Maxillofacial Surgery Service and showing a fracture in the mandibular region that attended from January 1, 2017, to February 28, 2019, were reviewed. The fracture site, incidence, etiology, age, gender, sex, and the state of the republic where the presents the traumatic event were recorded.
The data collected was collected at convenience with the following inclusion criteria: patients over 18 years of age, with lower third fractures, who have a medical history and consent informed, that these patients have imaging studies (plain X-rays or CT scans) that corroborate the diagnosis. The exclusion criteria were: patients without imaging studies, patients with an incomplete medical history, without signed informed consent, and lacking lower third fractures or greenstick fractures. Descriptive statistics analysis was performed with the Stata/SE 14.0 software program.
RESULTS
In the period covered by this study, 674 patients with trauma to the maxillofacial region were treated, of which 184 patients had a mandibular fracture. The age of the patients ranged from 18 to 63 years (average 24 years). The highest incidence of fractures that occurred was at 23 years (8.20%), 19 years (6.01%), 24 and 27 years (5.46%). Regarding the sex variable, 9.24% corresponds to females and 90.76% to males, in a 1:9 ratio. The most frequent fracture's site was the right mandibular angle, with 25.15% for males and 23.53% for females; the right mandibular angle fracture was present in 25%, left mandibular angle fracture 22.28%, left parasymphysis 12% and the less frequent, left condyle and coronoid, as well as dentoalveolar (0.54% respectively for each one) (Figure 1). The state with the highest index of mandibular trauma was Mexico City (62.5%), followed by the State of Mexico (25%) and the rest of the country (12.5%).
According to the distribution of assessment by mandibular treatments per year during the study period, in 2018, the highest number of assessments of mandibular trauma was found, corresponding to a total of 101 events (54.89%) compared to the other two years presented in the study (2017-2019), with a ratio of 5:1. The treatments performed were open reduction and internal fixation, 68.3%, conservative 0.55%, and no treatment 31.15%.
Regarding the etiology, physical attacks by third parties occupy the most commonplace, with a total of 143 patients (77.78%), followed by motorcycle accidents with 19 patients (10.56%) and 15 patients by falls (7.78%), car accidents two patients (1.11%) and unknown five patients (2.78%). No patients with mandibular fractures caused by projectile with a firearm were identified (Figure 2).
DISCUSSION
In this study, interpersonal violence is the most common cause of mandibular fractures, being the male gender is the highest incidence (90.76%), which could be explained because those who try to resist physical aggression or assault are, in most cases, males. Likewise, the data obtained in the present study differs to published by other authors, in that the most common mechanism of trauma was motorcycle accidents with 30.7% followed by gunshot wounds with 21.5%, being able to mention that in Mexico, people are more physically attacked and direct and not with firearm projectiles.9 However, the same result is reached with similar studies11 having a higher incidence of physical aggressions, followed by motorcycle accidents. However, we know that the etiology will depend on the country where it occurs due to cultural and social differences in the environment.
Something to highlight in this article is that we can know the area where the assaulted people belong, such as Mexico City, with 62.53% of the mandibular fractures of the General Hospital of Balbuena.
There is a significant difference in gender in mandibular fractures, agreeing with the article by González de Santiago6 in which the male is the gender with the highest number of mandibular fractures.
Most mandibular fractures are accompanied by other fractures of the facial massif in general, being thus an anatomical area of great importance for a statistical study of facial fractures, but they are not in broad relation to fractures of the cranial region.
CONCLUSION
The Balbuena General Hospital is a hospital with a high incidence of facial trauma, hence the importance of this study to determine the incidence of mandibular fractures in our service.
This study seeks to provide necessary information on the types of fractures treated in our service, mainly mandibular ones. However, it is crucial to continue research on mandibular fractures since little information exists from different country hospitals on this topic and the importance of correlating the mechanism of injury and the force vector in mandibular fractures with cervical or neurovascular injuries.
REFERENCES
AFFILIATIONS
1 Servicio de Cirugía Oral y Maxilofacial del Hospital General de Balbuena. México.
CORRESPONDENCE
Carlos Armando Cruz-Correa. E-mail: dr.armandocorrea@hotmail.comReceived: Mayo 2020. Accepted: Junio 2020.