Dental Traumatology 2014; doi: 10.1111/edt.12129
Elderly patients with maxillofacial trauma: study of mandibular condyle fractures Shinnosuke Nogami1, Kensuke Yamauchi1, Toshio Yamashita2, Yoshihiro Kataoka3, Bunichi Hirayama1, Kenko Tanaka1, Tetsu Takahashi1 1 Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai; 2Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, Fukuoka; 3Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
Key words: mandibular condyle fractures; elderly; maxillofacial trauma Correspondence to: Shinnosuke Nogami, Division of Oral and Maxillofacial Surgery, Department of Oral Medicine, and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Miyagi, Japan Tel.: +81-22-717-8350 Fax: +81-22-717-8354 e-mail: [email protected]
Abstract – Background/Aim: The aim of this study was to investigate the trends and characteristic features of mandibular condyle fractures in elderly patients in terms of etiology, patterns, and treatment modalities. Patients and methods: Records of 201 patients aged 65 years and older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University from January 2002 to December 2013, were retrospectively analyzed. Patient records and radiographs were examined, with the following information: relevant medical history, cause of fracture, the presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fracture, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted. Results: A fall was responsible for the majority of the fractures (173/201). With condyle fractures, there was a significant difference between the contacted and non-contacted group in regard to incidence. Furthermore, there was a significantly greater number of cases with symphysis and condyle combination fractures in the non-contacted group (70.9%) than in the contacted group (51.9%). As for the method of treatment, arthrocentesis was the most commonly employed. Conclusions: The present findings suggest that contacted molars in the maxilla and mandible have an influence on condyle fractures in elderly individuals.
Accepted 17 July, 2014
Maxillofacial trauma has generally been shown to be more common in younger age groups, although the incidence is increasing in older individuals (1), which may be a reflection of increasing longevity and more active lifestyles among the elderly (2). The annual occurrence of injuries in older individuals has been reported to be as high as 29% (3), and substantial differences in response to trauma between older, young, and middle-age populations have been shown (2). Although the treatment principles are basically the same, patient condition, such as limited number of residual teeth, bone atrophy, and reduced capacity for tissue repair, has an influence on the treatment modality chosen for a maxillofacial fracture (4). Furthermore, the prevalence of pre-existing disease contributes to increased morbidity in older patients, who have limited physiologic reserve in their cardiovascular and pulmonary systems (5). Therefore, an understanding of the etiology, pattern, and consequences of maxillofacial fractures in elderly individuals is essential for better treatment and also to develop more effective therapy and possibly prevent injuries (2). Yamamoto et al. reported that fractures most often occurred in the mandible of elderly patients with maxillofacial fractures (6), © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
even though it is considered to be the strongest and most rigid bone in the facial structure. This could be explained by its prominent location, which may increase its exposure to risk factors (7). In patients with mandibular fractures, 64.6% fractures were located in the condyle, while mandibular condyle fractures are also found in many elderly patients (6). Some reports have observed a greater frequency of condylar fractures in patients without an impacted lower third molar (8, 9). The purpose of the present study was to analyze the trends and characteristic features of mandibular condyle fractures in older patients in terms of etiology and pattern, as well as treatment modalities employed. Patients and Methods
A total of 201 elderly patients aged 65 years and older, (94 males, 107 females) seeking treatment for a mandibular fracture at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University during the 11-years period from January 2002 to December 2013 were the subjects of this retrospective study. Ages ranged from 65 to more than 86 years, with the largest percentage aged from 76 1
2
Nogami et al.
Table 1. Age and sex of geriatric patients who sustained maxillofacial fractures Sex Age group (years)
Male
Female
Total
Percentage (%)
65–75 76–85 >86 Total
43 49 2 94
41 50 16 107
84 99 18 201
41.8 49.3 8.9 100
to 85 years (n = 99, 49.3%) (Table 1). The average age of all was 74.2 4.6 (SD) years, while that for males was 71.7 5.4 years and for females was 76.8 5.6 years. Patient records and radiographs were used to obtain the following information: relevant medical history, cause of fractures, presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fractures, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted. The premolars and molars include healthy permanent teeth, prosthetic appliance (i.e., bridge and crown), and stable denture. The patients were divided into two groups: contacted and non-contacted. For this study, the mandible was divided into five regions: condyloid process, ramus, angle, body, and symphysis. We used the definition of a mandibular angle fracture reported by Kelly and Harrigan (10) as follows: a fracture located posterior to the second molar extending from any point on the curve formed by the junction of the body and ramus in the retromolar area to any point on the curve formed by the inferior border of the ramus of the mandible. A condyle fracture was defined as a fracture with the fracture line extending over the sigmoid notch, body fracture was defined as that extending forward up to the mental foramen, and symphysis fracture was defined as that between the two mental foramina. None of the patients had a lower third molar. Patients younger than 65 years and those with isolated dental and alveolar fractures were excluded from this study. Data were analyzed by calculating the means standard deviation, and cohort comparisons were performed using a chi-square test and Student’s t-test. A P value
Elderly patients with maxillofacial trauma: study of mandibular condyle fractures Shinnosuke Nogami1, Kensuke Yamauchi1, Toshio Yamashita2, Yoshihiro Kataoka3, Bunichi Hirayama1, Kenko Tanaka1, Tetsu Takahashi1 1 Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai; 2Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, Fukuoka; 3Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
Key words: mandibular condyle fractures; elderly; maxillofacial trauma Correspondence to: Shinnosuke Nogami, Division of Oral and Maxillofacial Surgery, Department of Oral Medicine, and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Miyagi, Japan Tel.: +81-22-717-8350 Fax: +81-22-717-8354 e-mail: [email protected]
Abstract – Background/Aim: The aim of this study was to investigate the trends and characteristic features of mandibular condyle fractures in elderly patients in terms of etiology, patterns, and treatment modalities. Patients and methods: Records of 201 patients aged 65 years and older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University from January 2002 to December 2013, were retrospectively analyzed. Patient records and radiographs were examined, with the following information: relevant medical history, cause of fracture, the presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fracture, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted. Results: A fall was responsible for the majority of the fractures (173/201). With condyle fractures, there was a significant difference between the contacted and non-contacted group in regard to incidence. Furthermore, there was a significantly greater number of cases with symphysis and condyle combination fractures in the non-contacted group (70.9%) than in the contacted group (51.9%). As for the method of treatment, arthrocentesis was the most commonly employed. Conclusions: The present findings suggest that contacted molars in the maxilla and mandible have an influence on condyle fractures in elderly individuals.
Accepted 17 July, 2014
Maxillofacial trauma has generally been shown to be more common in younger age groups, although the incidence is increasing in older individuals (1), which may be a reflection of increasing longevity and more active lifestyles among the elderly (2). The annual occurrence of injuries in older individuals has been reported to be as high as 29% (3), and substantial differences in response to trauma between older, young, and middle-age populations have been shown (2). Although the treatment principles are basically the same, patient condition, such as limited number of residual teeth, bone atrophy, and reduced capacity for tissue repair, has an influence on the treatment modality chosen for a maxillofacial fracture (4). Furthermore, the prevalence of pre-existing disease contributes to increased morbidity in older patients, who have limited physiologic reserve in their cardiovascular and pulmonary systems (5). Therefore, an understanding of the etiology, pattern, and consequences of maxillofacial fractures in elderly individuals is essential for better treatment and also to develop more effective therapy and possibly prevent injuries (2). Yamamoto et al. reported that fractures most often occurred in the mandible of elderly patients with maxillofacial fractures (6), © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
even though it is considered to be the strongest and most rigid bone in the facial structure. This could be explained by its prominent location, which may increase its exposure to risk factors (7). In patients with mandibular fractures, 64.6% fractures were located in the condyle, while mandibular condyle fractures are also found in many elderly patients (6). Some reports have observed a greater frequency of condylar fractures in patients without an impacted lower third molar (8, 9). The purpose of the present study was to analyze the trends and characteristic features of mandibular condyle fractures in older patients in terms of etiology and pattern, as well as treatment modalities employed. Patients and Methods
A total of 201 elderly patients aged 65 years and older, (94 males, 107 females) seeking treatment for a mandibular fracture at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University during the 11-years period from January 2002 to December 2013 were the subjects of this retrospective study. Ages ranged from 65 to more than 86 years, with the largest percentage aged from 76 1
2
Nogami et al.
Table 1. Age and sex of geriatric patients who sustained maxillofacial fractures Sex Age group (years)
Male
Female
Total
Percentage (%)
65–75 76–85 >86 Total
43 49 2 94
41 50 16 107
84 99 18 201
41.8 49.3 8.9 100
to 85 years (n = 99, 49.3%) (Table 1). The average age of all was 74.2 4.6 (SD) years, while that for males was 71.7 5.4 years and for females was 76.8 5.6 years. Patient records and radiographs were used to obtain the following information: relevant medical history, cause of fractures, presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fractures, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted. The premolars and molars include healthy permanent teeth, prosthetic appliance (i.e., bridge and crown), and stable denture. The patients were divided into two groups: contacted and non-contacted. For this study, the mandible was divided into five regions: condyloid process, ramus, angle, body, and symphysis. We used the definition of a mandibular angle fracture reported by Kelly and Harrigan (10) as follows: a fracture located posterior to the second molar extending from any point on the curve formed by the junction of the body and ramus in the retromolar area to any point on the curve formed by the inferior border of the ramus of the mandible. A condyle fracture was defined as a fracture with the fracture line extending over the sigmoid notch, body fracture was defined as that extending forward up to the mental foramen, and symphysis fracture was defined as that between the two mental foramina. None of the patients had a lower third molar. Patients younger than 65 years and those with isolated dental and alveolar fractures were excluded from this study. Data were analyzed by calculating the means standard deviation, and cohort comparisons were performed using a chi-square test and Student’s t-test. A P value
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