Incidence of Concussion in Patients With Isolated Mandible Fractures

Abstract

IMPORTANCEThis study examines the association between isolated mandible fractures and mild traumatic brain injury (mTBI).OBJECTIVE To determine the rates of mTBI in patients who have sustained isolated mandible fractures. DESIGN, SETTING, AND PARTICIPANTSA prospective study was conducted among patients who sustained isolated mandible fractures within 24 hours of presentation. Patients were administered the Military Acute Concussion Evaluation (MACE). Recorded data included demographics, time since injury, use of alcohol or illicit drugs, nonfacial pain, and mechanism of injury. All patients were evaluated in the emergency department of a level I trauma center between June 20, 2013, and June 20, 2014. In addition, discharge data from the Nationwide Inpatient Sample database was analyzed to identify current rates of patients with a diagnosis of both mandible fractures and concussions.MAIN OUTCOMES AND MEASURES Rates of concussion. Patients with a MACE score of less than 25 were considered to have mTBI.RESULTS Sixteen patients met the study criteria over a 1-year period. Fourteen patients (88%) were male, and mean age was 27.5 years. The mean time since injury was 11.25 hours (range, 3-21 hours). The mechanism of injury was assault in 12 patients (75%), sports in 2 patients (13%), all-terrain vehicle crash in 1 patient (6%), and biking in 1 patient (6%). Eight patients (50%) admitted to the use of alcohol, and none reported the use of illicit drugs. Eleven patients (69%) reported loss of consciousness. Twelve patients (75%) met criteria for concussion according to the MACE. Among these 12 patients, 7 (58%) admitted to the use of alcohol at the time of injury. There was no relationship between the rates of concussion and the use of alcohol.CONCLUSIONS AND RELEVANCE Mandible fractures are often sustained after high-force impacts during altercations between men. In our study, a 75% (12 of 16) rate of concussions associated with isolated mandible fractures was identified. Patients with isolated mandible fractures may benefit from being screened for concussion and referred to a concussion clinic.LEVEL OF EVIDENCE 4.

Patterns Associated with Adult Mandibular Fractures in Southern Taiwan—A Cross-Sectional Retrospective Study

“…Because of the structure and anatomic proximity of the mandible as well as its direct connection to the skull base, trauma to the mandible is related to intracranial injury, and traumatic brain injuries were observed in 19% of trauma patients with mandibular fractures [ 20 ]. A 75% (12 of 16) rate of concussions associated with isolated mandible fracture has been reported [ 21 ]. Similarly, closed head injury has been identified in 32.4% of patients with mandible fractures caused by motor vehicle accidents [ 22 ].…”

A 6-Year Epidemiological Study of Mandibular Fractures in Traumatic Patients in North of Iran: Review of 463 Patients

“…In developing countries, traffic accidents are the main cause of mandibular fractures, however, interpersonal violence and physical assault are the most common cause of this kind of fracture in developed countries 8,9 . In the United States, the most frequent cause of mandible fractures is motor vehicle accidents and interpersonal violence 10 . Jaw fractures can occur alone or along with other facial bone fractures 11 .…”

A retrospective analysis of the relationship between facial injury and mild traumatic brain injury

“…However, the literature focusing on the association of facial injuries and the mild type of TBI is limited. A recent publication showed that 75% (12 of 16 patients) of isolated mandible fractures were associated with cerebral concussion or mild TBI . Mild traumatic brain injury (mTBI) is defined by the American Academy of Neurology (1997) as “trauma‐induced alteration in mental status that may or may not involve loss of consciousness.” The clinical features may include: loss of consciousness, loss of memory before or after the accident, alteration in mental state and focal neurological deficit(s)…”

“…Despite the detrimental complications, the literature indicates that mTBI injuries are often left unreported or underdiagnosed …”

“…11 Despite the detrimental complications, the literature indicates that mTBI injuries are often left unreported or underdiagnosed. 8,12 The aim of this study was to determine whether there is an association between facial injuries and mTBI. prises Kuala Lumpur and its suburbs, plus adjoining cities and towns in the state of Selangor.…”