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. 2020 Mar;13(1):9-14.
doi: 10.1177/1943387520903159. Epub 2020 Feb 10.

Mandibular Ramus Fractures: A Proposed Classification

Padmanidhi Agarwal  1 , Divya Mehrotra  2
Affiliations

Mandibular Ramus Fractures: A Proposed Classification

Padmanidhi Agarwal et al. Craniomaxillofac Trauma Reconstr. 2020 Mar.

Abstract

Aims: The purpose of this article was to study and devise a classification of fracture patterns of the mandibular ramus to facilitate management.

Methods: Mandibular ramus fracture demographics in literature were reviewed along with evaluation of the patients diagnosed with mandibular ramus fractures who had reported to the emergency/outpatient clinic of our Institute in the last 5 years. Epidemiology of these ramus fractures was studied, and these ramus fractures were categorized into repetitive patterns on the basis of radiological observations in an effort to achieve a simplified classification.

Results: A total of 1372 trauma patients were diagnosed with mandibular fractures, of which an incidence of 2.4% was recorded for ramus fractures. These were predominantly in males and mainly due to road traffic accidents commonly in people driving two-wheeler vehicles (64%). Ramus fractures seldom occur in isolation. Five predictable fracture patterns were observed and accordingly classified as types I to V. Type I was the most common and type IV the least. Open reduction was done in 45.5% patients with non-compression plating systems. Satisfactory aesthetic and functional outcomes were achieved in all patients.

Conclusion: The mandibular ramus fractures although rare need to be well understood and demarcated. The classification highlights the importance of this mandibular buttress and focuses on the importance of its technically and anatomically more complicated fracture treatment. Future studies are needed to compare the modalities of management.

Keywords: classification; incidence; mandible; mandibular fractures; open fracture reduction; ramus.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Classification of Mandibular Ramus Fractures. Type I: Vertical/oblique fracture line extending from the sigmoid notch to either the inferior border or angle of mandible. Type II: Vertical/oblique fracture line extending from coronoid process to either the inferior border or angle of mandible. Type III: Horizontal fracture line extending from anterior border to posterior border of ramus of mandible. Type IV: Oblique fracture line extending from posterior border of ramus to inferior border of mandible (separating the angle segment). Type V: Comminuted fracture of ramus of mandible (may cause isolated fractures of the coronoid, condyle, and the angle of mandible).
Figure 2.
Figure 2.
Open Reduction and Internal Fixation (ORIF) performed: A, Two-point ORIF done with one plate near the lower border for types I and II. B, Choices for fixation for types III, IV and V.
See this image and copyright information in PMC

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