Mandibular fractures in aged patients - Challenges in diagnosis

Abstract

Background/aims: Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features of mandibular fractures in aged patients and the effect of age on possible missed diagnoses.

Material and methods: Patients aged over 60 years with a recent mandibular fracture were included in the study. The outcome variable was a missed mandibular fracture during the patient's first assessment in the primary health care facility. Predictor variables were age group, categorized as older adults (aged ≥60 and <80 years), elders (aged >80 years), patient's age as a continuous variable and age sub-group divided into decades. Additional predictor variables were the patient's memory disease and injury associated with intracranial injury. Explanatory variables were gender, injury mechanism, type of mandibular facture, combined other facial fracture, edentulous mandible/maxilla/both, surgical treatment of the mandibular fracture, and scene of injury.

Results: Mandibular fractures were missed in 20.0% of the 135 patients during their first healthcare assessment. Significant associations between missed fractures and age group, gender, fracture type, or injury mechanism were not found. By contrast, memory disorder (p = .02) and site of injury (p = .02) were significantly associated with missed fractures. Fractures were missed more frequently in patients who were in hospital or in a nursing home at the time of injury.

Conclusions: There is an increased risk of undiagnosed mandibular fractures in the aged population. Small injury force accidents may cause fractures in old and fragile individuals. Careful examination is necessary, especially in patients with memory disorder.

Keywords: aged patient; geriatric patient; mandibular fracture; missed diagnose.

FIGURE 1

A 63‐year‐old woman with no diagnosed diseases or medications visited emergency care the same day after falling on the ground. The patient was examined at the hospital emergency polyclinic, and the skin wound on the anterior lower jaw was sutured. Despite pain in the jaw, the patient did not seek further emergency services until 2 weeks later when the skin had become red and swollen, and the edges of the wound were infected. During the second evaluation, a sub‐mental abscess was detected. The patient was referred to an ear, nose, and throat clinic, from which she was referred onward to maxillofacial surgery care. Clinical examination raised suspicion of a mandibular fracture. Dental panoramic tomography showed bilateral mandibular condyle fractures and suspicion of a symphyseal fracture (arrows).

FIGURE 2

Computer tomography confirmed the diagnosis of a symphyseal fracture (arrow)

FIGURE 3

The patient underwent surgery for the sub‐mental abscess and the fractures. The symphysis fracture was repositioned and fixated with titanium plates and screws, and residual teeth were removed 14 days after the injury.