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.