11. A Follow-up Study of 229 Patients

During the period 1964-73, 286 patients were treated for mandibular fractures. 229 patients (80%) at- tended the follow-up examination. The length of observa- tion was from 1 to 9 years. The treatment and the follow- up evaluations in the 229 patients are described. Early fracture treatment has been the objective, also in patients who have undergone severe cerebral traumas. Antibiotic prophylaxis was implemented in cases of compound fractures. Preservation of teeth and tooth buds in the line of fracture was attempted. Clinical infection occurred in 0.4% of the patients. At the follow-up examination 1 patient presented with a fracture displacement out- side the condylar process. Neither malocclusion nor pseudarthrosis following fracture or after treatment were seen. Permanent sensory disturbances in the innervation area of the mental nerve following fracture occurred in 8%. Radiological examination of the teeth in the line of fracture revealed unnoticed apical bone lesions in 17% of 118 patients. In a further 23% there was a negative re- sponse to the vitality test. Follow-up control of mandibu- lar fractures is advised at 12 to 18 months after treatment. Numerous investigations of mandibular fractures and their treatment have been presented. However, follow-up evaluations of the treatment, apart from investigations of condylar fractures, are rare. Some authors are sceptical as to the practicability of follow-up examinations due to a presumed lack of patient comprehension of this point (Enghoff & Siemssen, 1956). Other authors have not been able to achieve sufficient patient response (Blomquist & Cassel, 1964). Lundin, Ridell, Sandberg & Ohman (1973) had an attendence of 3 1 % in their follow-up of complications following facial fractures. Facial sensory disturbances following fractures have been described by several authors (Dingman & Natvig, 1964; Rowe & Killey, 1968). Some authors find that persisting sensory disturbances corresponding to the innervation area of the infraorbital nerve seem to be far more frequent than formerly presumed (Lund, 1971; Nordgaard, 1976). The frequency of the persisting sensory disturbances in the innerva- tion area of the mental nerve do not appear to have been investigated. Fixation problems in patients with violent subconscious muscular movements fol- lowing brain traumas are briefly described by Rowe & Killey . Follow-up investigations for evaluating the treatment of mandibular fractures in such pa- tients do not appear to have been undertaken. This present study describes the follow-up evalu- ation of 229 patients treated for mandibular fractures, representing an attendance of 80% of 286 patients. The presentation also includes a descrip- tion of the treatment and results obtained in patients where mental instability due to brain traumas in- volved special treatment problems. Sensory dis- turbances in the innervation area of the mental nerve at the follow-up examination have been evaluated. The frequency of unnoticed damage to teeth and tooth buds in the fracture line is il- lustrated. Pre-determined control times following treatment of mandibular fractures are proposed.