Treatment rationale for pathological fractures of the mandible: a series of 44 fractures

This paper reports on the largest series of pathological fractures of the mandible (n = 44) in the literature, with the aim of proposing an aetiologic classification and algorithm for treatment. A retrospective review was undertaken of cases treated in the Department of Oral and Maxillofacial Surgery at the University of Maryland Medical Center from 1991 to 2005. Data collected included age, gender, race, aetiology, site, management and outcome. Forty-three patients with 44 pathologic fractures were included. The most common aetiology was osteoradionecrosis (49%), followed by infections (19%) and malignancy (19%). The most frequent primary treatment utilized was mandibular resection of diseased bone and fixation with a locking reconstruction plate alone (55%). Either primary or secondary mandibular reconstruction was performed when co-morbid disease allowed such treatment. Management of pathological fractures is aimed initially at systemic issues, followed by focusing on site-specific issues. This is a complex problem with a 40% complication rate, with radiation therapy associated with 59% of the complications. Free flap reconstruction should be considered when possible, especially in cases secondary to osteoradionecrosis.