The influence of the mandibular gonial angle on the occurrence of mandibular angle fracture

Abstract

Background/Aims Angle fractures represent the largest percentage of mandibular fractures. They pose as a unique entity because of their codependent morphological dynamic factors, rendering the understanding of the mechanism, and treatment challenging. The aim of this study was to analyze the association between the mandibular gonial angle and the risk of mandibular angle fracture while highlighting its clinical relevance. Materials and Methods A retrospective analysis of radiographs of patients treated for mandibular fractures was done. The factors studied were as follows: the presence of a high gonial angle and an impacted third molar. The outcome was mandibular angle fracture. The gonial angle was measured using Planmeca Digital Software 3.7.0.R. Status of the third molar was also noted. Data obtained were analyzed using SPSS 22 (IBM Corp, Armonk, NY). Results The sample comprised 70 mandibular fractures (32 angle fractures and 38 non‐angle fractures). The mean gonial angle in the angle fracture group was 128.5 ± 5.4º which was 10.2° larger than in the non‐angle group (mean 118.5 ± 4.4º; P = 0.0001). Patients with a high gonial angle were 8.7 times more likely to sustain an angle fracture than those with normal or low gonial angles. A statistically significant relationship between the presence of impacted third molar and patients sustaining mandibular angle fractures was noted (P = 0.0001). Conclusion Subjects with a high gonial angle and an impacted third molar are at an increased risk for mandibular angle fracture due to direct and indirect morphological factors.

Magnitude of gonial angle influence on the commonness of mandibular angle fractures

“…The mandibular gonial angle has a significant implication to other anthroporadiometric values of the mandible, which include mean cortical thickness, panoramic mandibular index, mandibular height, and intensity of muscle pull. [ 4 9 10 ] It is an important anthropometric feature which contributes to facial esthetics and biodynamics of masticatory musculature. In practice, gonial angle is assessed by radiographic analysis.…”

“…Although lateral cephalogram is the preferred radiograph used to determine the gonial angle, OPGs were used in both the studies, as they are the established norm of assessing angle fractures and were the only available data. [ 1 4 ] The accuracy of OPG in assessing the gonial angle has been established by a study conducted by Bhullar et al . [ 11 ] Studies indicated that OPGs provide more precise measurement of the gonial region, as they do not demonstrate overlap of right and left angles, as observed in lateral cephalograms.…”

“…also included the impact of third molars on mandibular angle fracture, this may affect the result of an association between the angle fracture and gonial angle. [ 4 ] Dhara et al . also studied the variables of age; gender, and status of the third molar, which were found to be insignificantly associated with mandibular angle fracture.…”

“…[ 1 2 3 ] This region is designated as a triangular area with the superior edge being the junction of the horizontal body and vertical ramus usually where the third molar is or was located. [ 4 ] The higher incidence has been attributed to the curvature at the angle region, the presence of impacted third molar, and height of mandible at the angle. [ 1 ] The poor quality of the bone at the angle region has also been demonstrated as a cause of fracture.…”

Analisis ketebalan kortikal, ukuran sudut dan kepadatan trabekula tulang mandibula prajurit dan non prajurit ditinjau dari radiograf panoramik

“…Kondisi ini terjaya sejakan dengan nilia MCW yang diperoleh. Hal ini sesuai dengan penelitian yang dilakukan oleh Vasantha Dhara.et al, 18 yang menyatakan bahwa individu dengan sudut gonial besar memiliki nilai MCW lebih rendah, hal ini menunjukkan kurangnya kualitas tulang rahang di daerah sudut mandibula sehingga meningkatkan potensi terjadinya fraktur. 18 Sebaliknya, hasil pengukuran nilai GA pada prajurit berusia 40-58 tahun ternyata lebih tinggi dibanding non prajurit, hal ini kemungkinan faktor psikologis dari prajurit ternyata juga mampu mempengaruhi pertmbuhan dan perkembangan dari tulang.…”