A multicentric prospective analysis of unilateral double mandibular fractures among 12 European maxillofacial centers: an EURMAT (European Maxillofacial Trauma) project

BACKGROUND: Unilateral double mandibular fractures (UDMFs) represent a rare variant of facial trauma, characterized by a free mandibular segment lacking anterior or posterior support, making anatomical reduction and occlusal restoration particularly challenging. Current literature on this injury pattern is limited, and no prospective multicentric studies have been published to date. METHODS: A prospective multicenter analysis was conducted across 12 European centers participating in the EURMAT project. All patients with UDMFs treated with open reduction and internal fixation (ORIF) between May 2021 and April 2022 were included. Patients were divided into two groups: with (Group 1) and without (Group 2) condylar involvement. Demographic, clinical, radiological, and surgical data were col- lected, and follow-up evaluations were conducted at 6 weeks and 3 months postoperatively. Primary outcomes included postoperative complica- tions, such as malocclusion and infections. RESULTS: Among 446 patients with facial fractures, 23 presented with UDMFs (5.2%). Most patients were male (83%), with a median age of 33 years. The most common causes were assaults and road traffic accidents (35% each). Rigid fixation was the predominant treatment approach across both groups. In Group 2, soft tissue infections had a higher incidence in patients treated with non-rigid osteosynthesis compared to those treated with rigid or mixed osteosynthesis, although the difference did not reach statistically significance (P=0.07, Fisher’s Exact Test). No major malocclusions were observed. CONCLUSIONS: This first prospective multicenter study confirms the rarity of UDMFs, primarily affecting young males and typically resulting from high-energy trauma. Surgical management across participating centers showed a consistent preference for rigid ORIF, which was associ- ated with a lower risk of postoperative infections, supporting its role as the standard approach in UDMF treatment.