Mandibular fractures: the problem patient.

Of 110 adult patients with 163 mandibular fractures treated at University of Pennsylvania Graduate Hospital from 1964 to 1974, 17% had a history of previous mandibular fractures. All patients' medical records and X-rays were reviewed. Because of the characteristics of this patient population, it seems well suited for discussion as a problem group. Mandibular fractures in this urban area are most commonly caused by blows of a fist and the patient is often intoxicated, which impedes diagnosis, delays treatment, and probably results in further complications from injuries. Patients frequently do not comply with treatment recommendations, do discontinue immobilization, and fail to return for followup, even for removal of intermaxillary fixation. Almost one third had insufficient teeth for fixation; many had poor oral hygiene, and teeth in the fracture line, which led to complications. Osteomyelitis resulting in nonunion and requiring bone grafting occurred in seven patients. Recommended are: simplest fixation methods, minimal amounts of surgery, and as few extractions as possible. Experience from this patient group may be of help whenever a problem patient is seen with a mandibular fracture.