Accepted Manuscript Fracture of the genial tubercles of the mandible: case report and review of the literature A.C. Van Leeuwen , E.H. van der Meij , Jgam de Visscher PII:
S0278-2391(14)00500-X
DOI:
10.1016/j.joms.2014.05.001
Reference:
YJOMS 56316
To appear in:
Journal of Oral and Maxillofacial Surgery
Received Date: 17 April 2014 Accepted Date: 2 May 2014
Please cite this article as: Van Leeuwen A, van der Meij E, de Visscher J, Fracture of the genial tubercles of the mandible: case report and review of the literature, Journal of Oral and Maxillofacial Surgery (2014), doi: 10.1016/j.joms.2014.05.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Fracture of the genial tubercles of the mandible: case report and review of the literature Authors: AC Van Leeuwen, EH van der Meij, JGAM de Visscher
8901 BR Leeuwarden, The Netherlands.
SC
Keywords:
RI PT
Department of Oral and Maxillofacial Surgery, Medical Centre Leeuwarden, P.O. Box 888,
M AN U
Genial tubercles, fracture, review
Corresponding author: AC van Leeuwen, Department Oral and Maxillofacial Surgery University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
Abstract
TE D
[email protected]
Fracture of the genial tubercles is a rare occurrence and may occur as a solitary fracture or an
EP
associated fracture of the mandible. A solitary fracture seems to be associated with severe atrophy of the mandible. A report of a case of fractured genial tubercles in an eighty year-old
AC C
edentulous female patient is presented and a review of the literature is given.
1. Introduction The genial tubercles are situated on the lingual surface of the symphysial region of the mandible below the alveolar ridge. There are four tubercles: two superior tubercles to which the genioglossus muscles are attached and two inferior tubercles to which the geniohyoid
ACCEPTED MANUSCRIPT muscles find their origin. The tubercles are normally quite small. They may enlarge by degenerative calcification of the genioglossal ligament and become more prominent due to mandibular alveolar ridge atrophy. Fracture of the genial tubercles is a rare occurrence and may occur as an isolated fracture or concomitant injury in association with a fracture of the
RI PT
mandible.
A spontaneous isolated fracture of the tubercles may occur as a result of normal muscular activity, but usually the presence of a lower denture is a causative factor. The assumed
SC
mechanism is that the lower denture presses on the tubercles and causes (micro)fractures due to the action of the attached musculature. Treatment options are conservative treatment and
M AN U
surgical intervention. 1-3
In the present paper, a case of fractured genial tubercles and a review the literature on this rare condition is given.
TE D
2. Case report
An eighty year-old edentulous female patient was referred to the oral and maxillofacial surgery department with a clinical suspected mandible fracture. The day before she had
history of trauma.
EP
experienced a cracking sound during eating followed by pain and dysphagia. There was no
AC C
Intra-oral examination showed a haematoma in the floor of the mouth (figure 1). Movement of the tongue was painful. The alveolar mandibular ridge was grossly resorbed. Inspection and palpation of the anterior part of the mandible did not reveal signs of fracture. A provisional clinical diagnosis of a fractured genial tubercle was made. A panoramic and occlusal radiograph did not reveal the fractured genial tubercles (Figure 2A and B). The provisional diagnosis was confirmed by computed tomography (CT) which showed that the bone fragment was displaced distally from the inner aspect of the mandible towards the center
ACCEPTED MANUSCRIPT of the floor of the mouth (Figure 3). Therapy consisted of conservative treatment and the use of analgesics. Two weeks later the patient had no complaints and there was a normal function of the tongue.
RI PT
3. Historical review of the literature
The first report of a fracture of the genial tubercles and treatment was described in 1840
wherein a wagoner was crushed by the passing wheel of his loaded wagon over the lower jaw. This resulted in a bilateral fracture of the lower jaw with retraction of the anterior part of
SC
1
bone by the muscles of the tongue. The patient was able to drag the tongue in a forward
M AN U
position with the help of a spoon to enable breathing. Treatment consisted of repositioning of the displaced fragments and fixation with metal wires to the teeth. In 1894, a case of a 26 year old soldier was reported who suffered from a mandible fracture with separation of the genial tubercles. 1 This patient was surgically treated by surgical intervention whereby the mandible
TE D
fracture and the fracture of the genial tubercles were fixated.
3.1. Review of the literature
EP
For the literature search PubMed and Web of Knowledge were considered and the term “genial tubercles” was used This literature survey yielded a total of 24 case reports on the
AC C
fracture of genial tubercles as a solitary fracture or combined with a mandibular fracture. The case reports in which the fracture of the genial tubercles was part of a mandibular fracture were excluded and only isolated fractures were included. This lead to a total of 16 case reports on isolated fractures of the genial tubercles (Table 1). All patients were edentulous, had atrophied mandibles and wore lower dentures. There were 3 males and 13 females and the age of the patients ranged from 46-86 years with a mean age
ACCEPTED MANUSCRIPT of 69 years. The extent to which atrophy of the mandible had occurred (i.e. the residual height) had not been described in any of the reported cases. About half of the patients reported of a cracking sound followed by a sharp pain. The clinical signs and symptoms seen at admission generally consisted of pain and swelling, hematoma in
RI PT
the floor of the mouth, restricted tongue movement and pain during swallowing. Respiratory distress was not encountered in any of the cases. On oral examination a fracture of the genial tubercles was readily not demonstrated. Radiographical imaging revealed in all cases a
SC
fracture of the genial tubercles. Out of the 16 patients with an isolated fracture of the genial tubercles 11 were treated conservatively and 5 surgically. Of the surgically treated patient, in
M AN U
4 patients the muscles were reattached to the mandible whereas in 1 patient the fractured tubercles were removed. In all 16 cases recovery was uneventful.
TE D
4. Discussion
The genial tubercles may become (relatively) enlarged and prominent due to a combination of calcification in the tendinous insertion of the geniohyoid and genioglossus muscles and
EP
atrophy of the mandible. 4-7
Various causes for an isolated fracture of the genial tubercles have been hypothesized
AC C
including osteoporosis and repetitive increased stress and strain at the region of the genial tubercles by ill-fitting lower dentures in combination with gross mandibular atrophy. 8. The vast majority of fractures of the genial tubercles seem to be associated with extensive mandibular atrophy and stresses due to the wearing and bearing of dentures. Elder people are more affected which can be explained by the fact that elderly people normally have a longer history of being edentulous and are therefore more prone to extensive mandibular atrophy. Radiographical imaging is paramount to confirm the clinical diagnosis of fractured genial
ACCEPTED MANUSCRIPT tubercles. In the literature, panoramic, lateral oblique, posterior-anterior and occlusal radiographs and computed tomography have been used to establish the diagnosis. The first three radiographical imaging modalities are of no assistance in confirming the clinical diagnosis of a fracture of the genial tubercles. Occlusal radiographs may be of assistance
RI PT
when the fractured genial tubercles are not displaced to distally in the floor of the mouth. Also, patients with a hyperactive gag reflex can be a problem when occlusal radiographs are to be taken.
SC
When the provisional diagnosis of a fracture of the genial tubercles is made, cone-
beamcomputed tomography is preferred over conventional radiographical imaging to confirm
M AN U
the diagnosis and the extent of displacement of the fractured fragment.
When the diagnosis is made, treatment may consist of surgical reposition and fixation, or conservative treatment. Although surgical intervention has been advocated by some authors in the past 9-13, literature reports 8, 14-16 have shown that conservative treatment leads almost
TE D
unequivocally to good clinical outcome. In the reported case, the patient was treated conservatively with excellent clinical outcome.
In dentate patients with a fracture of the genial tubercles combined with various mandibular
EP
fractures, conservative treatment is reported to be have good clinical outcome. 1, 17, 18.In conclusion there seems to be no need for surgical treatment of fractures of the genial
AC C
tubercles.
5. Conclusion
A fracture of the genial tubercles may occur either as an isolated fracture or in combination with other mandibular fractures. Computed tomography and cone beam computed tomography should be used to confirm or to rule out a fracture of the genial tubercles. Since
ACCEPTED MANUSCRIPT conservative treatment shows good results, surgical treatment, e.g. reposition and fixation, is not necessary.
Acknowlegdements
RI PT
We, the authors, herewith declare that we did not receive any funding and that there were not
AC C
EP
TE D
M AN U
SC
any conflicts of interest.
ACCEPTED MANUSCRIPT References
1. Davis GG: III. Fracture of the Lower Jaw with Separation of the Genial Tubercle. Ann
RI PT
Surg 19, 1894
2. Smyd ES: Fracture of the genial tubercles. J Am Dent Assoc 55:136, 1957
3. Glendinning DEH, Hirschmann PN: Fractures of Genial Tubercles - 2 Cases and a Review
SC
of Literature. Br J Oral Surg 14, 1977
report. Dent Update 39, 2012
M AN U
4. Burnett PJ, Nixon PP, Rogers SN: Spontaneous fracture of the genial tubercles: a case
5. Goebel WM: Fractured Genial Tubercles. J Prosthet Dent 39, 1978
TE D
6. Kar Mun Yuen: Isolated fracture of th genial tubercles: Report of a case. Asian Journal of Oral and Maxillofacial Surgery 23:210, 2011
EP
7. Carroll MJ: Spontaneous Fracture of the Genial Tubercles. Br Dent J 154, 1983
8. Redelinghuys IF, Holtshousen WSJ: Fracture of the genial tubercles associated with a
AC C
mandibular denture: a clinical report and review of the literature. SADJ : Journal of the South African Dental Association = tydskrif van die Suid-Afrikaanse Tandheelkundige Vereniging 66:230, 2011
9. Yassutaka Faria Yaedu R, Regina Fisher Rubira-Bullen I, Sant'Ana E: Spontaneous fracture of genial tubercles: case report. Quintessence international (Berlin, Germany : 1985) 37, 2006
ACCEPTED MANUSCRIPT 10. Reifman S: Genial Tubercle Fracture - Report of a Case. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 27, 1969
11. Shipman B: Genial tubercle fracture: a case. Va Dent J 53, 1976
RI PT
12. Santosoller JM, Gutierrez LMJ, Rodriguez JCD, Pendas SL: Spontaneous Fracture of Hypertrophied Genial Tubercles. Oral Surgery Oral Medicine Oral Pathology Oral Radiology
SC
and Endodontics 74, 1992
13. Youngs R, Albert D: Fractured Genial Tubercles. J Laryngol Otol 98, 1984
M AN U
14. Shohat I, Shoshani Y, Taicher S: Fracture of the genial tubercles associated with a mandibular denture: A clinical report. J Prosthet Dent 89, 2003
15. Burnett CA, Clifford TJ: A case of fractured genial tubercles. Dent Update 20, 1993
TE D
16. Gallego L, Junquera L, Villarreal P, de Vicente JC: Spontaneous fracture of the mandibular genial tubercles. A case report. Medicina oral, patologia oral y cirugia bucal 12,
EP
2007
17. Maw RB, Lindsay JS: Conservative Management of Genial Tubercle Fractures. Oral
AC C
Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 30, 1970
18. Ryan JM, Ross D, Obeid G: Genial Tubercle Fracture: A Case Report and Review of the Literature. Journal of Oral and Maxillofacial Surgery 68, 2010
ACCEPTED MANUSCRIPT Figure legends
Figure 1: Light photograph showing the haematoma on the floor of the mouth.
RI PT
Figure 2A and B: Orthopantomogram and occlusal radiograph showing neither clear signs of fracture(s) of the mandible nor the genial tubercles. It can be clearly seen that
SC
there is severe atrophy of the mandible.
Figure 3: 3D–reconstructed computed tomography scan views showing the fractured
AC C
EP
TE D
M AN U
segment. The fractured and retracted genial tubercles can clearly be seen.
ACCEPTED MANUSCRIPT
Table 1: Treatment and outcome for the cases of genial tubercle fractures described in the literature. Age and Sex
Signs and symptoms
Imaging technique
Smyd (1957) 2
NA M
Cracking sound and
Occlusal radiograph
pain, ecchymosis of
Glendinning et al.
46 F
some ability in tongue movement after 2 weeks.
Surgery: removal of
Full/uneventful
and edema of the
posteroanterior and
fractured tubercles,
recovery of tongue
repositioning
movement
EP
occlusal radiographs
musculature
Cracking sound, pain
Lateral oblique,
Surgery: removal of
Full/uneventful
and edema of the
posteroanterior and
fractured tubercles,
recovery
floor of the mouth
occlusal radiographs
repositioning
AC C
73 F
Partial recovery:
Lateral oblique,
floor of the mouth
Shipman (1976) 11
Outcome at review
Cracking sound, pain
TE D
70 F
M AN U
mouth, restriction of
Reifman (1969) 10
Conservative
SC
the floor of the
tongue movement
Treatment
RI PT
Reference
Cracking sound, pain
musculature Orthopantomogram
Conservative in both
Full/uneventful
ACCEPTED MANUSCRIPT
77 F
and edema of the
and occlusal
floor of the mouth.
radiographs in both
Non-symptomatic
cases
swelling of the floor
Carroll (1983) 7
68 F
Ecchymosis, pain and Occlusal radiographs
Conservative
recovery of tongue
the mouth.
function
Ecchymosis, pain and Lateral and occlusal
Conservative
AC C
13
Pain and edema of
the floor of the mouth.
Full/uneventful recovery of tongue
EP
radiographs
the mouth.
77 M
Full/uneventful
edema of the floor of
edema of the floor of
Youngs et al. (1984)
recovery of tongue function
M AN U
65 M
TE D
Goebel (1978) 5
SC
of the mouth
cases
RI PT
(1977) 3
function
Occlusal radiographs
Surgery: removal of
Full/uneventful
fractured tubercles
recovery
ACCEPTED MANUSCRIPT
68 F
(1992) 12
Pain and edema of
Orthopantomogram
Surgery: removal of
Full/uneventful
the floor of the
and occlusal
fractured tubercles,
recovery of tongue
mouth.
radiographs
RI PT
Santos-Oller et al.
repositioning
function
musculature
15
Cracking sound, pain and edema of the floor of the mouth.
70 F
Cracking sound,
Orthopantomogram
Conservative
function
Conservative
Full/uneventful
pain, ecchymosis and
and occlusal
recovery of tongue
edema of the floor of
radiographs
function
EP
14
Full/uneventful recovery of tongue
TE D
Shohat et al. (2003)
Occlusal radiographs
SC
69 F
M AN U
Burnett et al. (1993)
Yassutaka et al. (2006) 9
63 F
AC C
the mouth.
Pain and edema of
the floor of the
Occlusal radiographs
Surgery: removal of
Full/uneventful
fractured tubercles,
recovery of tongue
ACCEPTED MANUSCRIPT
mouth.
repositioning
function
86 F
16
Pain, ecchymosis and
Orthopantomogram
Conservative
edema of the floor of
and conventional
recovery of tongue
the mouth.
computed
function
SC
Gallego et al (2007)
RI PT
musculature Full/uneventful
Redelinghuys et al.
74 F
Conventional
Conservative
Full/uneventful
pain, ecchymosis and
computed
recovery of tongue
edema of the floor of
tomography
function
TE D
(2011) 8
Cracking sound,
M AN U
tomography
68 F
Pain, ecchymosis and
Orthopantomogram
edema of the floor of
and occlusal
recovery of tongue
the mouth.
radiographs
function
Cracking sound,
Orthopantomogram
AC C
Yuen (2011) 6
EP
the mouth.
Burnett (2012) 4
62 F
Conservative
Conservative
Full/uneventful
Full/uneventful
ACCEPTED MANUSCRIPT
occlusal radiographs
recovery of tongue
edema of the floor of
and conventional
function
the mouth.
computed
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EP
TE D
M AN U
SC
tomography
RI PT
pain, ecchymosis and
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EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
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EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
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EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
S0278-2391(14)00500-X
DOI:
10.1016/j.joms.2014.05.001
Reference:
YJOMS 56316
To appear in:
Journal of Oral and Maxillofacial Surgery
Received Date: 17 April 2014 Accepted Date: 2 May 2014
Please cite this article as: Van Leeuwen A, van der Meij E, de Visscher J, Fracture of the genial tubercles of the mandible: case report and review of the literature, Journal of Oral and Maxillofacial Surgery (2014), doi: 10.1016/j.joms.2014.05.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Fracture of the genial tubercles of the mandible: case report and review of the literature Authors: AC Van Leeuwen, EH van der Meij, JGAM de Visscher
8901 BR Leeuwarden, The Netherlands.
SC
Keywords:
RI PT
Department of Oral and Maxillofacial Surgery, Medical Centre Leeuwarden, P.O. Box 888,
M AN U
Genial tubercles, fracture, review
Corresponding author: AC van Leeuwen, Department Oral and Maxillofacial Surgery University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
Abstract
TE D
[email protected]
Fracture of the genial tubercles is a rare occurrence and may occur as a solitary fracture or an
EP
associated fracture of the mandible. A solitary fracture seems to be associated with severe atrophy of the mandible. A report of a case of fractured genial tubercles in an eighty year-old
AC C
edentulous female patient is presented and a review of the literature is given.
1. Introduction The genial tubercles are situated on the lingual surface of the symphysial region of the mandible below the alveolar ridge. There are four tubercles: two superior tubercles to which the genioglossus muscles are attached and two inferior tubercles to which the geniohyoid
ACCEPTED MANUSCRIPT muscles find their origin. The tubercles are normally quite small. They may enlarge by degenerative calcification of the genioglossal ligament and become more prominent due to mandibular alveolar ridge atrophy. Fracture of the genial tubercles is a rare occurrence and may occur as an isolated fracture or concomitant injury in association with a fracture of the
RI PT
mandible.
A spontaneous isolated fracture of the tubercles may occur as a result of normal muscular activity, but usually the presence of a lower denture is a causative factor. The assumed
SC
mechanism is that the lower denture presses on the tubercles and causes (micro)fractures due to the action of the attached musculature. Treatment options are conservative treatment and
M AN U
surgical intervention. 1-3
In the present paper, a case of fractured genial tubercles and a review the literature on this rare condition is given.
TE D
2. Case report
An eighty year-old edentulous female patient was referred to the oral and maxillofacial surgery department with a clinical suspected mandible fracture. The day before she had
history of trauma.
EP
experienced a cracking sound during eating followed by pain and dysphagia. There was no
AC C
Intra-oral examination showed a haematoma in the floor of the mouth (figure 1). Movement of the tongue was painful. The alveolar mandibular ridge was grossly resorbed. Inspection and palpation of the anterior part of the mandible did not reveal signs of fracture. A provisional clinical diagnosis of a fractured genial tubercle was made. A panoramic and occlusal radiograph did not reveal the fractured genial tubercles (Figure 2A and B). The provisional diagnosis was confirmed by computed tomography (CT) which showed that the bone fragment was displaced distally from the inner aspect of the mandible towards the center
ACCEPTED MANUSCRIPT of the floor of the mouth (Figure 3). Therapy consisted of conservative treatment and the use of analgesics. Two weeks later the patient had no complaints and there was a normal function of the tongue.
RI PT
3. Historical review of the literature
The first report of a fracture of the genial tubercles and treatment was described in 1840
wherein a wagoner was crushed by the passing wheel of his loaded wagon over the lower jaw. This resulted in a bilateral fracture of the lower jaw with retraction of the anterior part of
SC
1
bone by the muscles of the tongue. The patient was able to drag the tongue in a forward
M AN U
position with the help of a spoon to enable breathing. Treatment consisted of repositioning of the displaced fragments and fixation with metal wires to the teeth. In 1894, a case of a 26 year old soldier was reported who suffered from a mandible fracture with separation of the genial tubercles. 1 This patient was surgically treated by surgical intervention whereby the mandible
TE D
fracture and the fracture of the genial tubercles were fixated.
3.1. Review of the literature
EP
For the literature search PubMed and Web of Knowledge were considered and the term “genial tubercles” was used This literature survey yielded a total of 24 case reports on the
AC C
fracture of genial tubercles as a solitary fracture or combined with a mandibular fracture. The case reports in which the fracture of the genial tubercles was part of a mandibular fracture were excluded and only isolated fractures were included. This lead to a total of 16 case reports on isolated fractures of the genial tubercles (Table 1). All patients were edentulous, had atrophied mandibles and wore lower dentures. There were 3 males and 13 females and the age of the patients ranged from 46-86 years with a mean age
ACCEPTED MANUSCRIPT of 69 years. The extent to which atrophy of the mandible had occurred (i.e. the residual height) had not been described in any of the reported cases. About half of the patients reported of a cracking sound followed by a sharp pain. The clinical signs and symptoms seen at admission generally consisted of pain and swelling, hematoma in
RI PT
the floor of the mouth, restricted tongue movement and pain during swallowing. Respiratory distress was not encountered in any of the cases. On oral examination a fracture of the genial tubercles was readily not demonstrated. Radiographical imaging revealed in all cases a
SC
fracture of the genial tubercles. Out of the 16 patients with an isolated fracture of the genial tubercles 11 were treated conservatively and 5 surgically. Of the surgically treated patient, in
M AN U
4 patients the muscles were reattached to the mandible whereas in 1 patient the fractured tubercles were removed. In all 16 cases recovery was uneventful.
TE D
4. Discussion
The genial tubercles may become (relatively) enlarged and prominent due to a combination of calcification in the tendinous insertion of the geniohyoid and genioglossus muscles and
EP
atrophy of the mandible. 4-7
Various causes for an isolated fracture of the genial tubercles have been hypothesized
AC C
including osteoporosis and repetitive increased stress and strain at the region of the genial tubercles by ill-fitting lower dentures in combination with gross mandibular atrophy. 8. The vast majority of fractures of the genial tubercles seem to be associated with extensive mandibular atrophy and stresses due to the wearing and bearing of dentures. Elder people are more affected which can be explained by the fact that elderly people normally have a longer history of being edentulous and are therefore more prone to extensive mandibular atrophy. Radiographical imaging is paramount to confirm the clinical diagnosis of fractured genial
ACCEPTED MANUSCRIPT tubercles. In the literature, panoramic, lateral oblique, posterior-anterior and occlusal radiographs and computed tomography have been used to establish the diagnosis. The first three radiographical imaging modalities are of no assistance in confirming the clinical diagnosis of a fracture of the genial tubercles. Occlusal radiographs may be of assistance
RI PT
when the fractured genial tubercles are not displaced to distally in the floor of the mouth. Also, patients with a hyperactive gag reflex can be a problem when occlusal radiographs are to be taken.
SC
When the provisional diagnosis of a fracture of the genial tubercles is made, cone-
beamcomputed tomography is preferred over conventional radiographical imaging to confirm
M AN U
the diagnosis and the extent of displacement of the fractured fragment.
When the diagnosis is made, treatment may consist of surgical reposition and fixation, or conservative treatment. Although surgical intervention has been advocated by some authors in the past 9-13, literature reports 8, 14-16 have shown that conservative treatment leads almost
TE D
unequivocally to good clinical outcome. In the reported case, the patient was treated conservatively with excellent clinical outcome.
In dentate patients with a fracture of the genial tubercles combined with various mandibular
EP
fractures, conservative treatment is reported to be have good clinical outcome. 1, 17, 18.In conclusion there seems to be no need for surgical treatment of fractures of the genial
AC C
tubercles.
5. Conclusion
A fracture of the genial tubercles may occur either as an isolated fracture or in combination with other mandibular fractures. Computed tomography and cone beam computed tomography should be used to confirm or to rule out a fracture of the genial tubercles. Since
ACCEPTED MANUSCRIPT conservative treatment shows good results, surgical treatment, e.g. reposition and fixation, is not necessary.
Acknowlegdements
RI PT
We, the authors, herewith declare that we did not receive any funding and that there were not
AC C
EP
TE D
M AN U
SC
any conflicts of interest.
ACCEPTED MANUSCRIPT References
1. Davis GG: III. Fracture of the Lower Jaw with Separation of the Genial Tubercle. Ann
RI PT
Surg 19, 1894
2. Smyd ES: Fracture of the genial tubercles. J Am Dent Assoc 55:136, 1957
3. Glendinning DEH, Hirschmann PN: Fractures of Genial Tubercles - 2 Cases and a Review
SC
of Literature. Br J Oral Surg 14, 1977
report. Dent Update 39, 2012
M AN U
4. Burnett PJ, Nixon PP, Rogers SN: Spontaneous fracture of the genial tubercles: a case
5. Goebel WM: Fractured Genial Tubercles. J Prosthet Dent 39, 1978
TE D
6. Kar Mun Yuen: Isolated fracture of th genial tubercles: Report of a case. Asian Journal of Oral and Maxillofacial Surgery 23:210, 2011
EP
7. Carroll MJ: Spontaneous Fracture of the Genial Tubercles. Br Dent J 154, 1983
8. Redelinghuys IF, Holtshousen WSJ: Fracture of the genial tubercles associated with a
AC C
mandibular denture: a clinical report and review of the literature. SADJ : Journal of the South African Dental Association = tydskrif van die Suid-Afrikaanse Tandheelkundige Vereniging 66:230, 2011
9. Yassutaka Faria Yaedu R, Regina Fisher Rubira-Bullen I, Sant'Ana E: Spontaneous fracture of genial tubercles: case report. Quintessence international (Berlin, Germany : 1985) 37, 2006
ACCEPTED MANUSCRIPT 10. Reifman S: Genial Tubercle Fracture - Report of a Case. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 27, 1969
11. Shipman B: Genial tubercle fracture: a case. Va Dent J 53, 1976
RI PT
12. Santosoller JM, Gutierrez LMJ, Rodriguez JCD, Pendas SL: Spontaneous Fracture of Hypertrophied Genial Tubercles. Oral Surgery Oral Medicine Oral Pathology Oral Radiology
SC
and Endodontics 74, 1992
13. Youngs R, Albert D: Fractured Genial Tubercles. J Laryngol Otol 98, 1984
M AN U
14. Shohat I, Shoshani Y, Taicher S: Fracture of the genial tubercles associated with a mandibular denture: A clinical report. J Prosthet Dent 89, 2003
15. Burnett CA, Clifford TJ: A case of fractured genial tubercles. Dent Update 20, 1993
TE D
16. Gallego L, Junquera L, Villarreal P, de Vicente JC: Spontaneous fracture of the mandibular genial tubercles. A case report. Medicina oral, patologia oral y cirugia bucal 12,
EP
2007
17. Maw RB, Lindsay JS: Conservative Management of Genial Tubercle Fractures. Oral
AC C
Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 30, 1970
18. Ryan JM, Ross D, Obeid G: Genial Tubercle Fracture: A Case Report and Review of the Literature. Journal of Oral and Maxillofacial Surgery 68, 2010
ACCEPTED MANUSCRIPT Figure legends
Figure 1: Light photograph showing the haematoma on the floor of the mouth.
RI PT
Figure 2A and B: Orthopantomogram and occlusal radiograph showing neither clear signs of fracture(s) of the mandible nor the genial tubercles. It can be clearly seen that
SC
there is severe atrophy of the mandible.
Figure 3: 3D–reconstructed computed tomography scan views showing the fractured
AC C
EP
TE D
M AN U
segment. The fractured and retracted genial tubercles can clearly be seen.
ACCEPTED MANUSCRIPT
Table 1: Treatment and outcome for the cases of genial tubercle fractures described in the literature. Age and Sex
Signs and symptoms
Imaging technique
Smyd (1957) 2
NA M
Cracking sound and
Occlusal radiograph
pain, ecchymosis of
Glendinning et al.
46 F
some ability in tongue movement after 2 weeks.
Surgery: removal of
Full/uneventful
and edema of the
posteroanterior and
fractured tubercles,
recovery of tongue
repositioning
movement
EP
occlusal radiographs
musculature
Cracking sound, pain
Lateral oblique,
Surgery: removal of
Full/uneventful
and edema of the
posteroanterior and
fractured tubercles,
recovery
floor of the mouth
occlusal radiographs
repositioning
AC C
73 F
Partial recovery:
Lateral oblique,
floor of the mouth
Shipman (1976) 11
Outcome at review
Cracking sound, pain
TE D
70 F
M AN U
mouth, restriction of
Reifman (1969) 10
Conservative
SC
the floor of the
tongue movement
Treatment
RI PT
Reference
Cracking sound, pain
musculature Orthopantomogram
Conservative in both
Full/uneventful
ACCEPTED MANUSCRIPT
77 F
and edema of the
and occlusal
floor of the mouth.
radiographs in both
Non-symptomatic
cases
swelling of the floor
Carroll (1983) 7
68 F
Ecchymosis, pain and Occlusal radiographs
Conservative
recovery of tongue
the mouth.
function
Ecchymosis, pain and Lateral and occlusal
Conservative
AC C
13
Pain and edema of
the floor of the mouth.
Full/uneventful recovery of tongue
EP
radiographs
the mouth.
77 M
Full/uneventful
edema of the floor of
edema of the floor of
Youngs et al. (1984)
recovery of tongue function
M AN U
65 M
TE D
Goebel (1978) 5
SC
of the mouth
cases
RI PT
(1977) 3
function
Occlusal radiographs
Surgery: removal of
Full/uneventful
fractured tubercles
recovery
ACCEPTED MANUSCRIPT
68 F
(1992) 12
Pain and edema of
Orthopantomogram
Surgery: removal of
Full/uneventful
the floor of the
and occlusal
fractured tubercles,
recovery of tongue
mouth.
radiographs
RI PT
Santos-Oller et al.
repositioning
function
musculature
15
Cracking sound, pain and edema of the floor of the mouth.
70 F
Cracking sound,
Orthopantomogram
Conservative
function
Conservative
Full/uneventful
pain, ecchymosis and
and occlusal
recovery of tongue
edema of the floor of
radiographs
function
EP
14
Full/uneventful recovery of tongue
TE D
Shohat et al. (2003)
Occlusal radiographs
SC
69 F
M AN U
Burnett et al. (1993)
Yassutaka et al. (2006) 9
63 F
AC C
the mouth.
Pain and edema of
the floor of the
Occlusal radiographs
Surgery: removal of
Full/uneventful
fractured tubercles,
recovery of tongue
ACCEPTED MANUSCRIPT
mouth.
repositioning
function
86 F
16
Pain, ecchymosis and
Orthopantomogram
Conservative
edema of the floor of
and conventional
recovery of tongue
the mouth.
computed
function
SC
Gallego et al (2007)
RI PT
musculature Full/uneventful
Redelinghuys et al.
74 F
Conventional
Conservative
Full/uneventful
pain, ecchymosis and
computed
recovery of tongue
edema of the floor of
tomography
function
TE D
(2011) 8
Cracking sound,
M AN U
tomography
68 F
Pain, ecchymosis and
Orthopantomogram
edema of the floor of
and occlusal
recovery of tongue
the mouth.
radiographs
function
Cracking sound,
Orthopantomogram
AC C
Yuen (2011) 6
EP
the mouth.
Burnett (2012) 4
62 F
Conservative
Conservative
Full/uneventful
Full/uneventful
ACCEPTED MANUSCRIPT
occlusal radiographs
recovery of tongue
edema of the floor of
and conventional
function
the mouth.
computed
AC C
EP
TE D
M AN U
SC
tomography
RI PT
pain, ecchymosis and
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
