Multiple and comminuted mandibular fractures: treatment outlines in adverse medical conditions in Iraq

This study was conducted to evaluate prospectively the simple and more reliable methods in the treatment of multiple and comminuted mandibular fractures in hospitals with limited facilities and a high influx rate of trauma patients such as ours in Baghdad. One hundred patients with multiple and comminuted mandibular fractures of different severities were included in this study. Fifty-four patients were with comminuted and 46 were with multiple mandibular fractures. Eighty-eight patients had isolated mandibular fractures, and 12 had other associated facial bones fractures. Seventy-two patients were treated solely with maxillomandibular fixation. Thirteen patients were treated with different methods of internal fixation; the remainder was treated conservatively, functionally, or with different combinations of closed and open reduction methods. There was a statistically significant difference (P < 0.05) for fractures healing in relation to the type, severity, and etiology of the fracture. Eighty-four patients had fractures healed to bony union, 4 ended with nonunited fractures, and 10 patients had bone loss. Four patients developed infection, thus the infection rate was 4% for all, and 2.17% and 5.56% for patients with multiple and comminuted fractures, respectively. Seventeen patients required further surgeries for facial recontouring. The results of this study underscore the efficacy of closed reduction for treating multiple and comminuted mandibular fractures in terms of its simplicity, the availability of materials and instruments, and the favorable outcomes.