Scoring mandibular fractures: a tool for staging diagnosis, planning treatment, and predicting prognosis.

BACKGROUND: Mandibular fractures (MF) are a daily problem in maxillofacial surgery. A staging system for classifying MF is of paramount importance to plan surgery, to define prognosis, and to exchange information among trauma centers. In this article, a classification for MF is proposed. METHODS: The mandible is divided into six sites (symphysis, body, angle, ramus, coronoid, and condyle) and the mandibular nerve divides the alveolar process (i.e., the upper part containing teeth) from the basal bone (placed caudally with respect to the nerve). MF can be summarized using three abbreviations: A = alveolar, B = basal, and C = complete. Consequently, MFs are staged as follows: F in situ = a greenstick fracture; F1 = a single mobile fragment of alveolar or basal bone; F2 = double mobile fractures of the alveolar or basal portion or a single complete separation of the mandibular arch continuity; F3 = a complete double separation of the mandibular arch continuity; F4 = triple or more mandibular arch fragments. To evaluate the suitability of the proposed classification, a retrospective study on a series of 128 patients (and 205 MFs) was performed. Age, gender, stage, clinical diagnosis at admission, type of surgery, and outcome were considered. RESULTS: A good correlation between the proposed classification and the studied variables was detected. CONCLUSIONS: The new classification is a simple and precise method for staging MF. It can summarize MFs and be used in daily practice. It is our understanding, however, that a multicenter study should be performed before the effectiveness of the proposed classification can be clearly stated.

Mandibular condyle fractures: evaluation of the Strasbourg Osteosynthesis Research Group classification.

Condylar fractures (CFs) are about 30% of mandibular fractures. Condylar fractures are treated with several protocols, and unsatisfying outcome is achieved in some cases. A staging system for classifying CFs is of paramount importance to plan therapy, to define prognosis, and to exchange information among trauma centers. The Strasbourg Osteosynthesis Research Group proposed a classification system for CFs, but no report focusing to its effectiveness is still available. Thus, we performed a retrospective study on a series of patients affected by CFs.The Strasbourg Osteosynthesis Research Group classification defines 3 main types of CFs: diacapitular fracture (i.e., through the head of the condyle [DF]), fracture of the condylar neck, and fracture of the condylar base (CBF). A series of 66 patients (and 84 CFs) was evaluated, and age, sex, clinical diagnosis at admission, treatment, and outcome were considered.Fractures of the condylar base and DFs are the most (52.4%) and the least (4.8%) frequent fractures, respectively. Conversely, associated fractures of the facial skeleton are found in most cases of DFs (75%) and in few cases of CBFs (20.5%). Surgery was performed in about 15% of all cases: no DF was operated, whereas fractures of the condylar neck and CBFs have an open reduction and an internal rigid fixation in 57% and 43%, respectively. Postsurgical and late sequelae were 22.3% and 19%. Temporomandibular joint symptoms and malocclusion cover about 80% and 90% of postsurgical and late sequelae.The new classification is a simple method to define CFs and can give some elements about the prognosis.

Midfacial Fractures: A Scoring Method and Validation on 117 Patients.

The midfacial region (MR) is located in the middle-third of the face, composed of several bones and surrounded by complex anatomical structures so that MR fractures (MRFs) often involve other parts of the face. A staging system for classifying MRFs is of paramount importance in order to exchange information among trauma centers. Le Fort described three lines of fractures but still there is no scoring method to stage MRFs. In this article, a classification for MRFs is proposed. It is based on Le Fort's three lines and it defines seven facial units. MRFs can be staged as follows: F in situ = a fracture line without fragment mobility (i.e. greensticked); F1 = a fracture involving one MR unit (MRU); F2 = a fracture involving two MRUs; F3 = a fracture involving three MRUs; F4 = a fracture involving four or more MRUs or neighboring anatomical regions (i.e. mandible, orbit and skull). To evaluate the suitability of the proposed classification a retrospective study on a series of 117 MRFs was performed. Age, gender, new stage, clinical diagnosis at admission, type of surgery, and outcome were considered. A good correlation between the proposed classification and the studied variables was detected. In conclusion, the proposed classification is a simple and precise method of staging MRFs. It can summarize MRFs and be used in daily practice. It is our understanding, however, that a multi-centers study should be performed before the effectiveness of the proposed classification can be clearly stated.