Maxillofacial injuries are not uncommon in Pakistan ; among them mandibular fracture remain the major part of the

workload at maxillofacial units due to most frequently occurring injuries in the facial region.The facial trauma is presented in accident and emergency department of hospital as an isolated injury or part of poly trauma. The rapid mechanism of our society in the recent years coupled with the miserable condition of our roads has increased the incidence of maxillofacail trauma beyond any proportions. Mandible being the only mobile bone of the facial skeleton plays a major role in mastication, speech, deglutition, and patient life style because of its prominent projection on the face. t also forms the lower third of the face. ts fracture therefore,results in a se!er loss of function and disfigurement. The mandible is connected to the base of the skull by the temporomandibular joint. The mandibular fracture are one of most common fractures of facial skeleton.it may occur alone or in combination with other facial injuris . it is the second most common fractured bone in facial region after "asal bone and the tenth most common fractured bone in the body.

Historical background:
The first description of fracture mandible was as early as #$%& '.(. when )dward *mith Papyrus described the examination ,diagnosis and treatment of mandibular fractures and other surgical ailments. The case in which a mandibular fracture was described was thought to be incurable and therefore wasn+t treated; the patient subsequently died. )dwin *mith, an ,merican )gyptologist purchased a document disco!ered from )gyptian pyramids from an )gyptian nati!e in #-$.. t consisted of /- surgical cases. (ase no../ described a fracture of the mandible. The surgeon writes that it is less serious than a compound comminuted fracture of the long bone but described it fatal. ,!icenna was the first to describe the classical barrel bandage of today accredited to many who copied him in later years. n #.0% ,.1, talian 2uglielmo salicetti wrote about mandibular fractures. n a later edition printed in 3yons in #/4. he first proposed to wire the teeth adjacent to the fracture site. The celebrated 5rench surgeon ,mbroix published his work on mandibular fracture in#%0.. 6e proposed leather strip to be incorporated to chin part of the barrel bandage. 5renchman 5. (hopart and P.7. 1esault in #04% described the effect of the ele!ator and depressor muscles on fragments of the mandibular fracture. 8ramer9#4%:; presented a series of typical fractures of the mandible condyle process. <lasojoi et all reported in there :&$ cases on patient of mandibular fracture and determine that commonest age was .#=:& year, assault was the common cause while body of the mandible was the commonest site of fracture. ,bbas and coworkers ha!e reported that the most common cause of fracture mandible is >oad traffic accident and the age of most !ictims are from .# to :& years the male to female ratio was 4?# while the commonest site of fracture was Parasymphysis. )llis et al ha!e reported that ::@ of mandibular fractures occur at the body followed by

consular process .4@ A angle .:@. 8han , ,yyaB in his retrospecti!e study in 6arare re!ealed that the most commonest aetiology of fracture mandible was assault i.e. -#.$@ followed by road traffic accident #/.-@ and site was 'ody /-.4@ followed by ,ngle :4.#@ most of the patients were between .#=:& years of age. 3asaki et al in their study re!ealed that -&@ of males with the commonest age between .&=:& are sustained mandibular fractures. The assault was the commonest cause.

Hypothesis:5racture mandible is the mixture of many common factors which are pre!entable and in the e!ent of fracture should be managed early. This prospecti!e study was carried out on one hundred patients presentated with the fracture of the mandible in the department of oral and Maxillofacial *urgery Mayo 6ospital 3ahore. The prospecti!e study was undertaken in all patients. The patient with unilateral fracture mandible were selected presented in ,ccident and emergency department , out patient department and shifted from other wards or hospitals. ,fter thorough study and examination in!estigation done and diagnosis was made and data was collected according to patient+s age , sex , site and etiology of the fracture of the mandible. 5ire arm injuries are not included due to the communated type of fracture.

Age frequency :
.The age of the hundred !ictims are presented the age range was from # year to -. years mean age was ...-0 year. Patients were di!ided into six groups according to the age. The most common age group of patient in our study were .# to :& years old. ,ccording for the :#@ of the series and less common age incidence was $& years and more. Table # shows characteristic feature of the age distribution. T,'3)? # ,2) 1 *T> 'CT <" <5 T6) P,T )"T*

NO

AGE OF NO OF HE PE#$EN AGE PA !EN " PA !EN " &% O %& () 'EA#" O (& (( 'EA#" O +& +% 'EA#" O ,& %& 'EA#" O )& &'EA#" ,1( ()*

%%

((*

(%

+%*

+%

%&*

,%

&-*

)%' . A/O0E

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n our study -% males sustained fracture mandible while #% females presented with fracture. The male to female ratio in our study was -.% ? #.%. ,pplying the chi square test

air the data recei!ed that the P !alue is less than &.&# which is highly significant .

Aetiology of in2ury :
n our study %/ @ patients were presented with >oad traffic ,ccident. ,bout #% @ were injured by assault or interpersonal !iolence. .:@ cases were obser!ed in :@ cases. Dhile /@ cases were obser!ed with ndustrial trauma. # case is presented with hit by a horse. n the the relation between road traffic accident and fall was made A after data entry the p !alue is &.&% obtained which was significant wide mouth relation between >T, A ,ssault were made the P !alue was &.&# which is significant.

Mandibular parasymphasis fracture was found in :$ cases followed by body fracture which were :.. The angle fracture which was in #0 of cases, &- fractures of subcondylar region and &# case with condylar fracture was found. "o coronoid fracture was presented in our hundred study cases. The !alue of the fracture parasymphysis A body were two cases so the P !alue was greater then the &.&%. The assault was not significant but the relation of parasymphsis fracture that is other sites were less than &.&% so the result declared significant.

A/3E (: "E4 5!" #!/6 !ON

*)E M,3) 5)M,3) "<. <5 P,T )"T* -% #% P)>()"T,2) -%.& #%.& P Falue G&.&# G&.&#

A/3E +: Etiological factors of fracture 7andible8

"o.

A/3E ,: Anato7ical sites of the fracture 7andible8

The incidence of fracture mandible !aries with age, sex, geographical location, physical acti!ity, socioeconomic status , cultural and en!ironmental factors and traffic !olumes. n our *tudy predominance of the age group from .#=:& years was consistent with findings of

the pre!ious published work of de!eloped countries by motamedi M6 and 1ongas P. n de!eloping countries 6aq HC A (< workers, ,n sari M6 all showed that the common age was .#= :& years. 6owe!er , many age groups are found in our population but majority of the population in this age group were exposed more to external en!ironment rather than other age groups in comparison to age groups $& or more. >oad Traffic ,ccident accounted for the largest number of the fracture mandible in our study it is consistent with the studies carried out by ,nsari M6.6e showed that >oad Traffic ,ccident 9>T,; were $&@ of the total cases. n study of 'ad and coworkers was the commonest etiology. t is due to the lack of implication of the traffic laws and !iolation of traffic rules , increased traffic !olume, less usage of crash helmets and seat belts , broken roads , lack of traffic education , usage of old style !ehicles , social stresses, fatigue , cheaper mode of transportation i.e. motor cycle rickshaws 9also called Iinqi; , wheeling on bikes and fast dri!ing , no proper checking of !ehicle+s safety systems all this contributes the fracture of the mandible during a >oad traffic ,ccident. De ha!e obser!ed many cases of fracture mandible in motor cycle rikshaws . These are local made rickshaws and cheaper mode of transport. t has metallic body and poor controlling system and has tendency to turn turtle at the slightest turns so a little more mishap leads to serious injuries of maxillofacial region and sufferers are more at a time because it carries six to eight passengers at a time . <n the other hand assault replaced the road traffic accident as a commonest etiological factor of mandibular fracture in large number of de!eloped countries. 5alls were the second most common cause of fracture mandible . t was obser!ed to ha!e a bimodal age distribution i.e. between the age # to #& and $& years or abo!e supporting the results of another study of ,bbas A coworkers.

This corresponds to the result s deri!ed by ,bbas A coworkers in which she showed that the .4.#@ fracture were presented with fracture parasymphysis. Parasymphasis the !ictim of most of the blows in the road traffic accidents. The role of muscle attachments around the parasymphseal area also contribute to a higher proportion of the fractures of this area in our study.

$onclusion :
The prospecti!e study was concluded to e!aluate the frequency of fracture mandible in relation with age ,sex , site and etiology to impro!e the record keeping system , to reduce the incidence of the fractures of the mandible and e!aluate the changing pattern of etiology factors and gi!ing possible recommendations. Mandibular fractures are frequent site of the fracture in maxillofacial region and has a major workload in maxillofacial trauma centers. *uch fractures are easy to diagnose and after a meticulous examination the clinician correlate the physical signs with the underlying surgical anatomy by taking radiological aid. Proper diagnosis of the site and age group influence the treatment and its period. 5ollowing are the recommendations to reduce the frequency of fracture mandible. #. mpro!ement of the deplorable condition of roads. .. *tringent traffic rules and their strict implementation by the concerned authorities. :. (ompulsory wearing of crash helmets for motorcyclists and control on motor bike wheelin. /. (onduction of the traffic law education by concerned authorities.

%. To reduce the incidence of trauma there should be amendment in legislation about the proper use of seat belts. $.,ward of a J'est 1ri!er of the Kear ,ward J to those citiBens who ha!en+t gotten a traffic !iolation ticket in % years and display of their names in newspapers to encourage the common man to practice traffic laws. 0. ncrease policing , and impro!e street lights to decrease the incidence of interpersonal !iolence. -. (ontrol on traditional kite flying. 4 . mpro!e the building designs to reduce the incidence of falls. #&. *tringent industrial regulations and strict !igilance by the 1eptt of 3abour to reduce the incidence of industrial injuries with respect to facial injuries. ##. Mouth guards , safety helmets with proper paddind and front protection should be made a part of all sports