The surgical management of triple mandibular fractures: A challenging task

Background: The treatment of multiple mandibular fractures may often be challenging. The aim of this study was to evaluate the characteristics and outcomes of multiple mandibular fractures, with a focus on triple mandibular fractures. Material and Methods: Patients with multiple (triple) mandibular fractures were included. The following data were recorded for each patient: age; gender; cause of injury; sites of mandibular fractures; presence of complications. Facial width was esthetically evaluated through a clinical examination considering the inferior facial width, postoperative asymmetries, and facial esthetic harmony. Results: From January 1, 2010, to December 31, 2018, 25 patients (15 men, 10 women) underwent surgery for triple mandibular fractures and were included in the study. A predominance of symphysis/parasymphysis fracture associated with bilateral condylar/ramus fractures was observed, followed by symphysis/ parasymphysis fracture combined with mandibular angle fracture and condyle fracture. Most patients did not show any type of complications. An optimal esthetic outcome was obtained in 20 patients. Conclusions: A successful treatment of trifocal mandibular fractures may be achieved by different techniques, although it remains challenging. The re-establishment of the transversal bigonial dimension by a correct reconstruction of the mandibular arch should guide surgeons. The aim of the treatment should always be the successful rehabilitation of patients’ pretraumatic occlusion and function.