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Casereport:
A Rare Fracture of The Mandible

Sulabha AN1, Sameer AC2,Warad NM3
Abstract

Maxillofacial traumas are common and mandible is most frequently fractured bone in the lower third of face.
Here we report a rare horizontal fracture of mandible from right molar to left molar. Fracture was adequate-
ly reduced and fixed with two holed miniplates. The possible mechanism of such an unusual fracture is dis-
cussed.

Key Words: Horizontal fracture, mandible, reduction

Introduction
Maxillofacial injuries are common. They occur in a
variety of situations: road traffic accidents, interper-
sonal violence, as a result of criminal activity, fall or
during the contact sports 

1
. Mandible fractures occur

more frequently than any other fractures of the facial
skeleton. In urban areas in more recent years partic-
ularly, interpersonal violence has accounted for an
increasing proportion of the mandible fracture along
with zygomatic fractures

2.

The mandible constitutes the bony structure of the
lower third of the face .Mandible is the strongest and
most rigid component of the facial skeleton. It is
more commonly fractured than any other bone of
face, a fact directly related to its prominent and
exposed situations

2
. The most common sites of frac-

ture in mandible are angle, subcondylar area, body,
symphsis, ramus, coronoid process.

3

Here we report an isolated case of horizontal fracture
of mandible below the mental foramen resembling
the osteotomy for genioplasty. Extensive research
revealed only two cases of horizontal fracture of
symphysis.

Case report
A 35 year old female reported to department of oral
medicine with a complaint of swelling in the lower
mandibular region since 8-10 days. History revealed

that she was hit by a stone in the interpersonal vio-
lence 8-10 days before. She developed pain and
swelling for which she consulted local dentist and
his prescription revealed her of pain and swelling but
not completely.

Extra oral examination revealed mild swelling along
entire lower mandibular region extending from
angle to angle. On palpation it was tender and soft.
Intraoral examination revealed no soft tissue abnor-
mality. Occlusion was normal. Panoramic view
showed isolated horizontal undisplaced fracture
from right molar to left below the mental foramen on
both sides (Fig-1).

1. Dr.  Sulabha .A.N.  Professor, Department of Oral Medicine and Radiology, Al-Ameen Dental College and
Hospital, Bijapur-586108, Karnataka

2. Dr. Sameer. A.C. Reader, Department of Oral and Maxillofacial Surgery, Al-Ameen Dental College and
Hospital, Bijapur-586108, Karnataka

3. Dr. Warad. N.M. Professor, Department of Oral and Maxillofacial Surgery, Al-Ameen Dental College and
Hospital, Bijapur-586108, Karnataka

Corresponds to: Dr. Sulabha. A. N. Professor, Department of Oral Medicine and Radiology, Al-Ameen Dental
College and Hospital, Bijapur-586108, Karnataka, India, E-mail: sulabha595@rediffmail.com

Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12

353

Fig-I Panoramic view of horizontal fracture of
mandible



Risdon’s degloving incision was taken from angle to
angle, blunt dissection was done to expose the frac-
ture site, and exposed fracture resembled horizontal
osteotomy (Fig-II). Fracture site was reduced and
two holed two miniplates were fixed on right and left
side of mandible at canine region. Incision closure
was done in layers (Fig-III). Postoperative healing
was uneventful (Fig-IV).

Discussion:
Despite the many variables associated with the etiol-
ogy of mandibular fractures, vehicular accidents and
assaults are undoubtedly the primary cause of the
mandibular fracture throughout the world.
Mandibular fracture are more prevalent in the inter-
personal violence when compared to accidents
which involves majority involves midfacial frac-
tures

4
.

The mandible has few mechanically weak portions
including angle, condylar precess and both sides of
mentum. The location and direction of mandibular
fracture are nearly constant, although the impacts
and direction of external force are variable

5
.

Mandible having long canines, unerupted third
molars, unerupted or absent premolars are signifi-
cantly weaker and represents the lines of weakness
along with the condylar process and both sides of
mentum, making these areas more prone for frac-
tures 

2,6
.

Isolated horizontal fracture of mandible are rare
5

.Only two cases have been reported in the litera-
ture.Ladeinde et al reported horizontal fracture of
mandibular symphsis, more involving the left body
of mandible caused by matchet cut

5
. Mitsukawa

reported a horizontal fracture of mandibular symph-
ysis resembling horizontal osteotomy for genioplas-
ty

7
. In contrast to only reported two cases, the pres-

ent case involved horizontal fracture from molar to
molar.

Lesser violence from interpersonal assaults tends to
cause fracture at the usual point of impact on one
side

2
. The object that caused the fracture can also

influence the type and number of fracture. A blow
from smaller well defined object may cause single
commutated fracture since the impact of force is
concentrated in smaller area

3
.

Horizontal fractures occur only when local stresses
exceed the ultimate strength of the bone in that
region. Only an object approaching at high speed
could produce enough of impact force to fracture the
bone in non biomechanical pattern. The object
would have to have a horizontal orientation with a
sharp edge when striking the mandible and such an
acute loading would act like an osteotome to pro-
duce the fracture. In the present case high speed

A Rare Fracture of The Mandible

354

Fig-IV Postoperative radiograph

Fig-III Immediate postoperative Photograph 

Fig-II intraoperative photograph showing the hor-
izontal fracture



stone with enough of impact force, having sharp
edge might have acted as osteotome to cause such an
unusual fracture of mandible

5
.

To conclude such horizontal fractures very rare and

occurs when the local stresses exceed the ultimate
strength of bone and these fractures need to be clas-
sified in classification of mandibular fractures.

References
1. Booth Pw, Schendel SA, Hausamen JE.

Maxillofacial Surgery. Vol 1. Churchill
Livingstone, London; 1999: pg 3-11

2. Banks P. Killey’s fractures of the mandible. 4th
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pg 1-19

3. Fonseca RJ, Walker RV, Betts NJ, Barber HD.
Oral and Maxillofacial trauma. Vol 1. 2nd Ed.W
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http://dx.doi.org/10.1016/S03009785(78)80054-4

7. Mitsukawa N, Satoh K, Umeura T, Hosaka Y. An
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200403000-00011PMid:15167236

Sulabha AN, Sameer AC,Warad NM

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