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Incidence and management of mandibular fractures in a low-resource health facility in Ghana

  • Received : 2020.11.13
  • Accepted : 2021.01.21
  • Published : 2021.12.31

Abstract

Objectives: The mandible and other parts of the maxillofacial region suffer significant morbid injuries following road traffic accidents. Our study gives epidemiological description of mandibular fractures in Ghana and also evaluates the relevance of closed reduction and indirect fixation for managing mandibular fractures in low-resource health facilities in low-income countries like Ghana. Patients and Methods: This is a retrospective study involving 268 patients who reported to the Department of Oral and Maxillofacial Surgery of the Sunyani Regional Hospital with mandibular fractures from January 2010 to December 2019. Patient medical records were assessed for information on age, sex, fracture etiology, anatomic location of fracture, time of day of road traffic accident, and other associated injuries. Results: A total of 268 patients were included in this study (males, 216 [80.6%]; females, 52 [19.4%]). Motor vehicular accident (MVA) was the leading cause of mandibular fractures (202 injuries, 75.4%). Other etiologies included assault (39, 14.6%), gunshot (13, 4.9%), falls (12, 4.5%), and industrial accidents (2, 0.7%). Of the 161 male cases caused by MVA, 121 (75.2%) occurred at night and in the evening while the remaining 40 (24.8%) occurred in the morning and afternoon. Among all managed 222 patients, 212 (79.1%) were treated with closed reduction and indirect fixation technique while 10 (3.7%) were treated with open reduction and direct fixation. Conclusion: Closed reduction with indirect fixation could successfully be used to manage mandibular fractures in low resourced health facilities, especially in low-income countries. The poor lightening system on roads in Ghana is a major contributory factor to motor vehicular accidents.

Keywords

Acknowledgement

This study was supported by Basic Science Research Program funded by the Ministry of Education (2017R1D1A1B04029339) and by grant no 03-2019-0043 from the SNUDH Research Fund.

References

  1. Jin KS, Lee H, Sohn JB, Han YS, Jung DU, Sim HY, et al. Fracture patterns and causes in the craniofacial region: an 8-year review of 2076 patients. Maxillofac Plast Reconstr Surg 2018;40:29. https://doi.org/10.1186/s40902-018-0168-y
  2. Abadi M, Pour OB. Genioplasty. Facial Plast Surg 2015;31:513-22. https://doi.org/10.1055/s-0035-1567882
  3. Anyanechi CE, Saheeb BD. Mandibular sites prone to fracture: analysis of 174 cases in a Nigerian tertiary hospital. Ghana Med J 2011;45:111-4.
  4. Kim SM. Intraoral reinsertion after extracorporeal fixation in condylar fracture. J Korean Assoc Oral Maxillofac Surg 2021;47:476-9. https://doi.org/10.5125/jkaoms.2021.47.6.476
  5. Shah A, Shah AA, Salam A. Pattern and management of mandibular fractures: a study conducted on 264 patients. Pak Oral Dent J 2007;27:103-6.
  6. World Health Organization (WHO). WHO global status report on road safety 2013: supporting a decade of action. Geneva: WHO; 2013.
  7. Down KE, Boot DA, Gorman DF. Maxillofacial and associated injuries in severely traumatized patients: implications of a regional survey. Int J Oral Maxillofac Surg 1995;24:409-12. https://doi.org/10.1016/s0901-5027(05)80469-2
  8. Ellis E 3rd, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol 1985;59:120-9. https://doi.org/10.1016/0030-4220(85)90002-7
  9. Zhou H, Lv K, Yang R, Li Z, Li Z. Mechanics in the production of mandibular fractures: a clinical, retrospective case-control study. PLoS One 2016;11:e0149553. https://doi.org/10.1371/journal.pone.0149553
  10. Ragupathy K, Pasupathy S. Incidence, aetiology and pattern of mandibular fractures in Pondicherry. J Evol Med Dent Sci 2015;4:16946. https://doi.org/10.14260/jemds/2015/2555
  11. Amin MR, Chowdhury MAP, Sarwar MG, Moula SM, Kabir MH, Ahmed TI, et al. A retrospective study of mandibular fracture in a 2- year period. Bangladesh Dent J 2016;32:1-3.
  12. Barde D, Mudhol A, Madan R. Prevalence and pattern of mandibular fracture in Central India. Natl J Maxillofac Surg 2014;5:153-6. https://doi.org/10.4103/0975-5950.154818
  13. Fasola AO, Nyako EA, Obiechina AE, Arotiba JT. Trends in the characteristics of maxillofacial fractures in Nigeria. J Oral Maxillofac Surg 2003;61:1140-3. https://doi.org/10.1016/s0278-2391(03)00671-2
  14. Olayemi AB, Adeniyi AO, Samuel U, Emeka OA. Pattern, severity, and management of cranio-maxillofacial soft-tissue injuries in Port Harcourt, Nigeria. J Emerg Trauma Shock 2013;6:235-40. https://doi.org/10.4103/0974-2700.120362
  15. Parkins G, Boamah MO, Avogo D, Ndanu T, Nuamah IK. Maxillofacial and concomitant injuries in multiple injured patients at Korle Bu Teaching Hospital, Ghana. West Afr J Med 2014;33:51-5.
  16. Strom C, Nordenram A, Fischer K. Jaw fractures in the County of Kopparberg and Stockholm 1979-1988. A retrospective comparative study of frequency and cause with special reference to assault. Swed Dent J 1991;15:285-9.
  17. Layton S, Dickenson AJ, Norris S. Maxillofacial fractures: a study of recurrent victims. Injury 1994;25:523-5. https://doi.org/10.1016/0020-1383(94)90094-9
  18. Kheirallah M, Matenko D. [The epidemiological analysis of mandibular fractures in the material of I Department of Maxillofacial Surgery of Warsaw University in the years 1988-1992]. Czas Stomatol 1994;2:123-7. Polish.
  19. Ansari S, Akhdar F, Mandoorah M, Moutaery K. Causes and effects of road traffic accidents in Saudi Arabia. Public Health 2000;114:37-9. https://doi.org/10.1038/sj.ph.1900610
  20. Bereket C, Sener I, Senel E, Ozkan N, Yilmaz N. Incidence of mandibular fractures in black sea region of Turkey. J Clin Exp Dent 2015;7:e410-3. https://doi.org/10.4317/jced.52169
  21. Ravindran V, Ravindran Nair KS. Metaanalysis of maxillofacial trauma in the northern districts of Kerala: one year prospective study. J Maxillofac Oral Surg 2011;10:321-7. https://doi.org/10.1007/s12663-011-0264-3
  22. Natu SS, Pradhan H, Gupta H, Alam S, Gupta S, Pradhan R, et al. An epidemiological study on pattern and incidence of mandibular fractures. Plast Surg Int 2012;2012:834364. https://doi.org/10.1155/2012/834364
  23. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture patterns: a suburban trauma center experience. Am J Otolaryngol 2004;25:301-7. https://doi.org/10.1016/j.amjoto.2004.03.001
  24. Atanasov DT. A retrospective study of 3326 mandibular fractures in 2252 patients. Folia Med (Plovdiv) 2003;45:38-42.
  25. Wong KH. Mandible fractures: a 3-year retrospective study of cases seen in an oral surgical unit in Singapore. Singapore Dent J 2000;23(1 Suppl):6-10.
  26. Adebayo ET, Ajike OS, Adekeye EO. Analysis of the pattern of maxillofacial fractures in Kaduna, Nigeria. Br J Oral Maxillofac Surg 2003;41:396-400. https://doi.org/10.1016/s0266-4356(03)00165-7
  27. Tent PA, Popa D, Juncar RI, Harangus A, Lung T, Juncar M, et al. The pattern and characteristics of mandibular fractures - a 3-year prospective clinical study. ASRJETS 2017;32:168-80.
  28. Motamedi MH, Dadgar E, Ebrahimi A, Shirani G, Haghighat A, Jamalpour MR. Pattern of maxillofacial fractures: a 5-year analysis of 8,818 patients. J Trauma Acute Care Surg 2014;77:630-4. https://doi.org/10.1097/TA.0000000000000369
  29. Rix L, Stevenson AR, Punnia-Moorthy A. An analysis of 80 cases of mandibular fractures treated with miniplate osteosynthesis. Int J Oral Maxillofac Surg 1991;20:337-41. https://doi.org/10.1016/s0901-5027(05)80261-9
  30. Ogundare BO, Bonnick A, Bayley N. Pattern of mandibular fractures in an urban major trauma center. J Oral Maxillofac Surg 2003;61:713-8. https://doi.org/10.1053/joms.2003.50118
  31. Fridrich KL, Pena-Velasco G, Olson RA. Changing trends with mandibular fractures: a review of 1,067 cases. J Oral Maxillofac Surg 1992;50:586-9. https://doi.org/10.1016/0278-2391(92)90438-6
  32. Subhashraj K, Nandakumar N, Ravindran C. Review of maxillofacial injuries in Chennai, India: a study of 2748 cases. Br J Oral Maxillofac Surg 2007;45:637-9. https://doi.org/10.1016/j.bjoms.2007.03.012
  33. 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. https://doi.org/10.1016/j.bjoms.2005.03.014
  34. Elgehani RA, Orafi MI. Incidence of mandibular fractures in Eastern part of Libya. Med Oral Patol Oral Cir Bucal 2009;14:e529-32. https://doi.org/10.4317/medoral.14.e529
  35. Hill CM, Crosher RF, Carroll MJ, Mason DA. Facial fractures--the results of a prospective four-year-study. J Maxillofac Surg 1984;12:267-70. https://doi.org/10.1016/s0301-0503(84)80257-x
  36. Olson RA, Fonseca RJ, Zeitler DL, Osbon DB. Fractures of the mandible: a review of 580 cases. J Oral Maxillofac Surg 1982;40:23-8. https://doi.org/10.1016/s0278-2391(82)80011-6