Bart van Den Bergh

The aims of this study were to assess the clinical outcomes of patients with anterior bifocal mandibular fractures and to discuss the management of this peculiar type of trauma. From the systematic computer-assisted database that has continuously recorded patients hospitalized with maxillofacial fractures, only patients admitted with anterior bifocal bilateral mandibular fractures between 2001 and 2011 were considered. Patients were contacted, and they were invited to volunteer for a clinical follow-up examination. Statistical analysis was performed using the Fisher exact test, and P < 0.05 was considered statistically significant. Forty dentate patients with anterior bifocal bilateral mandibular fractures (without the presence of further mandibular fractures) were included in the study. Nineteen patients with dislocated anterior segment underwent surgical intervention within 12 hours from hospital admission in the emergency department, whereas 21 patients with nondisplaced mandibular fractures were surgically treated in the elective operating room within 72 hours. Only 3 patients underwent tracheostomy. All patients underwent open reduction and internal fixation with 2.0- and 2.4-mm plates via intraoral approach, except for patients with submental or submandibular facial lacerations. Anterior bifocal bilateral mandibular fractures may involve a challenging management because they can compromise the upper airway. Accurate reduction and internal fixation of these fractures have been critical to restoring form and function of the mandible. The upper airway management and securing always take first, but a prompt surgical intervention of dislocated fractures avoids upper airways impairment.