Mandibular Ramus Fractures: A Proposed Classification

Abstract

Aims: The purpose of this article was to study and devise a classification of fracture patterns of the mandibular ramus to facilitate management. Methods: Mandibular ramus fracture demographics in literature were reviewed along with evaluation of the patients diagnosed with mandibular ramus fractures who had reported to the emergency/outpatient clinic of our Institute in the last 5 years. Epidemiology of these ramus fractures was studied, and these ramus fractures were categorized into repetitive patterns on the basis of radiological observations in an effort to achieve a simplified classification. Results: A total of 1372 trauma patients were diagnosed with mandibular fractures, of which an incidence of 2.4% was recorded for ramus fractures. These were predominantly in males and mainly due to road traffic accidents commonly in people driving two-wheeler vehicles (64%). Ramus fractures seldom occur in isolation. Five predictable fracture patterns were observed and accordingly classified as types I to V. Type I was the most common and type IV the least. Open reduction was done in 45.5% patients with non-compression plating systems. Satisfactory aesthetic and functional outcomes were achieved in all patients. Conclusion: The mandibular ramus fractures although rare need to be well understood and demarcated. The classification highlights the importance of this mandibular buttress and focuses on the importance of its technically and anatomically more complicated fracture treatment. Future studies are needed to compare the modalities of management.

First report of mandibular ramus fracture associated with anterior dislocation of ipsilateral condyle into temporal fossa and locked jaw: A Rarity

“…There are different pattern of fracture in these areas, for instance, line either running obliquely from sigmoid notch to the posterior border of mandible, running horizontally from anterior border to posterior border of mandible, or running from coronoid process to posterior border of mandible. Agarwal et al [4] classified ramus fracture into five distinct pattern. The most commonly encountered fracture pattern in ramus fracture is type I & type II [4] .…”

“…Agarwal et al [4] classified ramus fracture into five distinct pattern. The most commonly encountered fracture pattern in ramus fracture is type I & type II [4] . In our case the fracture line is running from sigmoid notch to the angle of mandible with concomitant dislocation of condylar process anterior to the articular eminence which is a unique combination as it has not been reported in the literature till date.…”

“…The incidence of ramus fracture varies from 3 to 5 % amongst mandibular trauma patient as reported in various studies [1] , [2] , [3] , [4] . Due to lack of sufficient literature, ramus fracture is not well understood and demarcated.…”

Occurrence and pattern of mandibular fractures in maxillofacial trauma of Kerala population

“…[4,5,7) Road Traffic Accidents (RTA), industrial trauma, injuries sustained while participating in sports, assault, and falls are the leading causes of mandibular fractures. [1,8,9] The amount of energy needed to fracture the mandible is in the range of 44.6 to 74.4 kg/m, which is similar to the energy required to fracture the zygoma and almost half of that required to fracture the frontal bone. Mandibular fractures necessitate four times the force of maxillary fractures.…”

“…Fracture of the mandible may affect a single anatomic site or frequently several sites concurrently. [1,2,3] According to studies, between 36% and 59% of all maxillofacial fractures are caused by mandibular fractures and are twice as common as midfacial fractures. [4][5][6] Although maxillofacial fractures are frequently studied, it is impossible to reach a consensus on their patterns because all the epidemiologic surveys vary depending on the population density of the specific geographical area, mode of injury, educational level, and socioeconomic condition of its residents.…”