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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Clinical Features and Treatment Modes of Mandibular Fracture at the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, Japan</title><author><name sortKey="Tatsumi, Hiroto" sort="Tatsumi, Hiroto" uniqKey="Tatsumi H" first="Hiroto" last="Tatsumi">Hiroto Tatsumi</name><affiliation><nlm:aff id="aff001"><addr-line>Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Nakatani, Eiji" sort="Nakatani, Eiji" uniqKey="Nakatani E" first="Eiji" last="Nakatani">Eiji Nakatani</name><affiliation><nlm:aff id="aff002"><addr-line>Translational Research Informatics Center, Foundation Biomedical Research and Innovation, Kobe, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Kanno, Takahiro" sort="Kanno, Takahiro" uniqKey="Kanno T" first="Takahiro" last="Kanno">Takahiro Kanno</name><affiliation><nlm:aff id="aff001"><addr-line>Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Nariai, Yoshiki" sort="Nariai, Yoshiki" uniqKey="Nariai Y" first="Yoshiki" last="Nariai">Yoshiki Nariai</name><affiliation><nlm:aff id="aff001"><addr-line>Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Kagimura, Tatsuo" sort="Kagimura, Tatsuo" uniqKey="Kagimura T" first="Tatsuo" last="Kagimura">Tatsuo Kagimura</name><affiliation><nlm:aff id="aff002"><addr-line>Translational Research Informatics Center, Foundation Biomedical Research and Innovation, Kobe, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Sekine, Joji" sort="Sekine, Joji" uniqKey="Sekine J" first="Joji" last="Sekine">Joji Sekine</name><affiliation><nlm:aff id="aff001"><addr-line>Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan</addr-line></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26334627</idno><idno type="pmc">4559417</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559417</idno><idno type="RBID">PMC:4559417</idno><idno type="doi">10.1371/journal.pone.0136278</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000421</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000421</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Clinical Features and Treatment Modes of Mandibular Fracture at the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, Japan</title><author><name sortKey="Tatsumi, Hiroto" sort="Tatsumi, Hiroto" uniqKey="Tatsumi H" first="Hiroto" last="Tatsumi">Hiroto Tatsumi</name><affiliation><nlm:aff id="aff001"><addr-line>Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Nakatani, Eiji" sort="Nakatani, Eiji" uniqKey="Nakatani E" first="Eiji" last="Nakatani">Eiji Nakatani</name><affiliation><nlm:aff id="aff002"><addr-line>Translational Research Informatics Center, Foundation Biomedical Research and Innovation, Kobe, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Kanno, Takahiro" sort="Kanno, Takahiro" uniqKey="Kanno T" first="Takahiro" last="Kanno">Takahiro Kanno</name><affiliation><nlm:aff id="aff001"><addr-line>Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Nariai, Yoshiki" sort="Nariai, Yoshiki" uniqKey="Nariai Y" first="Yoshiki" last="Nariai">Yoshiki Nariai</name><affiliation><nlm:aff id="aff001"><addr-line>Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Kagimura, Tatsuo" sort="Kagimura, Tatsuo" uniqKey="Kagimura T" first="Tatsuo" last="Kagimura">Tatsuo Kagimura</name><affiliation><nlm:aff id="aff002"><addr-line>Translational Research Informatics Center, Foundation Biomedical Research and Innovation, Kobe, Japan</addr-line></nlm:aff></affiliation></author><author><name sortKey="Sekine, Joji" sort="Sekine, Joji" uniqKey="Sekine J" first="Joji" last="Sekine">Joji Sekine</name><affiliation><nlm:aff id="aff001"><addr-line>Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan</addr-line></nlm:aff></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>The number of elderly patients with maxillofacial trauma is rapidly increasing due to active lifestyles and longevity. Shimane prefecture has the fastest growing proportion of elderly individuals in Japan. The aim of this study was to reveal the distinctive features and treatment modes of mandibular fracture treatment mode in patients requiring hospitalization at the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, Japan.</p></sec><sec id="sec002"><title>Patients and Methods</title><p>Patient age, sex, period between injury and first consultation, years since injury, cause of injury, fracture site, treatment, and duration of hospitalization were evaluated. Univariate Poisson regression, relative risk with 95% confidence interval based on the Wald test, Fisher’s exact test, and Kruskal-Wallis test were used to explore associations among clinical and demographic variables.</p></sec><sec id="sec003"><title>Results</title><p>In total, 305 patients were diagnosed with and hospitalized for mandibular fracture from 1980 to 2010. Younger age increased the risk for mandibular fracture. Incidence was higher in males than females, particularly in the young, but the male to female ratio decreased with age. The period until first hospital consultation decreased progressively over the study period. Fall was a much more frequent cause in patients aged ≥60 than in those aged <60 years. Mandibular fracture with condyle, symphysis, and angle involvement were most common and were associated with sex, age, and treatment mode. Length of hospitalization has decreased since 1980.</p></sec><sec id="sec004"><title>Conclusion</title><p>In our department, patients aged ≥60 years accounted for a greater proportion of mandibular fracture cases than in many previous studies, reflecting the greater proportion of elderly residents in Shimane prefecture.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Goldschmidt, Mj" uniqKey="Goldschmidt M">MJ Goldschmidt</name></author><author><name sortKey="Castidlione, Cl" uniqKey="Castidlione C">CL Castidlione</name></author><author><name sortKey="Assael, La" uniqKey="Assael L">LA Assael</name></author><author><name sortKey="Litt, Md" uniqKey="Litt M">MD Litt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brasileiro, Bf" uniqKey="Brasileiro B">BF Brasileiro</name></author><author><name sortKey="Passeri, La" uniqKey="Passeri L">LA 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26334627</article-id><article-id pub-id-type="pmc">4559417</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0136278</article-id><article-id pub-id-type="publisher-id">PONE-D-14-43172</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Clinical Features and Treatment Modes of Mandibular Fracture at the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, Japan</article-title><alt-title alt-title-type="running-head">Mandibular Fracture in Shimane Prefecture</alt-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Tatsumi</surname><given-names>Hiroto</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Nakatani</surname><given-names>Eiji</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Kanno</surname><given-names>Takahiro</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Nariai</surname><given-names>Yoshiki</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kagimura</surname><given-names>Tatsuo</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sekine</surname><given-names>Joji</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref rid="cor001" ref-type="corresp">*</xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Translational Research Informatics Center, Foundation Biomedical Research and Innovation, Kobe, Japan</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Cray</surname><given-names>James</given-names><suffix>Jr.</suffix></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Medical University of South Carolina, UNITED STATES</addr-line></aff><author-notes><fn fn-type="conflict" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: JS. Performed the experiments: HT. Analyzed the data: EN T. Kanno T. Kagimura YN. Contributed reagents/materials/analysis tools: EN T. Kagimura. Wrote the paper: JS.</p></fn><fn fn-type="other" id="econtrib001"><p>‡ These authors also contributed equally to this work.</p></fn><corresp id="cor001">* E-mail: <email>georges@med.shimane-u.ac.jp</email></corresp></author-notes><pub-date pub-type="epub"><day>3</day><month>9</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>10</volume><issue>9</issue><elocation-id>e0136278</elocation-id><history><date date-type="received"><day>10</day><month>11</month><year>2014</year></date><date date-type="accepted"><day>1</day><month>8</month><year>2015</year></date></history><permissions><copyright-year>2015</copyright-year><copyright-holder>Tatsumi et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="pone.0136278.pdf"></self-uri><abstract><sec id="sec001"><title>Background</title><p>The number of elderly patients with maxillofacial trauma is rapidly increasing due to active lifestyles and longevity. Shimane prefecture has the fastest growing proportion of elderly individuals in Japan. The aim of this study was to reveal the distinctive features and treatment modes of mandibular fracture treatment mode in patients requiring hospitalization at the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, Japan.</p></sec><sec id="sec002"><title>Patients and Methods</title><p>Patient age, sex, period between injury and first consultation, years since injury, cause of injury, fracture site, treatment, and duration of hospitalization were evaluated. Univariate Poisson regression, relative risk with 95% confidence interval based on the Wald test, Fisher’s exact test, and Kruskal-Wallis test were used to explore associations among clinical and demographic variables.</p></sec><sec id="sec003"><title>Results</title><p>In total, 305 patients were diagnosed with and hospitalized for mandibular fracture from 1980 to 2010. Younger age increased the risk for mandibular fracture. Incidence was higher in males than females, particularly in the young, but the male to female ratio decreased with age. The period until first hospital consultation decreased progressively over the study period. Fall was a much more frequent cause in patients aged ≥60 than in those aged <60 years. Mandibular fracture with condyle, symphysis, and angle involvement were most common and were associated with sex, age, and treatment mode. Length of hospitalization has decreased since 1980.</p></sec><sec id="sec004"><title>Conclusion</title><p>In our department, patients aged ≥60 years accounted for a greater proportion of mandibular fracture cases than in many previous studies, reflecting the greater proportion of elderly residents in Shimane prefecture.</p></sec></abstract><funding-group><funding-statement>The authors have no support or funding to report.</funding-statement></funding-group><counts><fig-count count="0"></fig-count><table-count count="10"></table-count><page-count count="10"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>All relevant data are within the paper and its Supporting Information file.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>All relevant data are within the paper and its Supporting Information file.</p></notes></front><body><sec sec-type="intro" id="sec005"><title>Introduction</title><p>The incidence of maxillofacial fracture varies with population density, living environment, socioeconomic status, and road traffic conditions [<xref rid="pone.0136278.ref001" ref-type="bibr">1</xref>–<xref rid="pone.0136278.ref005" ref-type="bibr">5</xref>]. Most cases of maxillofacial trauma involve mandibular fracture [<xref rid="pone.0136278.ref002" ref-type="bibr">2</xref>–<xref rid="pone.0136278.ref004" ref-type="bibr">4</xref>], which in Japan is usually managed by departments of oral and maxillofacial surgery [<xref rid="pone.0136278.ref006" ref-type="bibr">6</xref>].</p><p>The number of elderly patients with maxillofacial trauma has increased in recent decades because of changes in lifestyle and an increase in the proportion of elderly patients in the population [<xref rid="pone.0136278.ref001" ref-type="bibr">1</xref>]. Statistics have shown that 22.7% of the Japanese population is ≥65 years of age, with elderly individuals accounting for a growing portion of the Japanese population. Indeed, the proportion of elderly is expected to expand by an additional 41.8% by the year 2050 [<xref rid="pone.0136278.ref007" ref-type="bibr">7</xref>]. Likewise, in other developed countries, the proportion of individuals ≥65 years of age is expected to increase to 26.2% [<xref rid="pone.0136278.ref008" ref-type="bibr">8</xref>]. With demographic and various social changes, such as the greater number of elderly living alone and leading an active retirement, the elderly population may be at increased risk for trauma, including maxillofacial fracture.</p><p>Shimane prefecture, located in western Japan, has the most rapidly increasing proportion of elderly individuals in Japan. Among its population of 710,000, approximately 31.1% are elderly [<xref rid="pone.0136278.ref007" ref-type="bibr">7</xref>]. Therefore, this area is a suitable setting for studying epidemiological changes associated with a rapidly aging society.</p><p>The aim of this study was to reveal the distinctive features of mandibular fracture cases hospitalized at the Department of Oral and Maxillofacial Surgery, Shimane University Hospital located in the center of the Shimane prefecture, and to elucidate the clinical features and treatment modes of mandibular fracture.</p></sec><sec sec-type="materials|methods" id="sec006"><title>Method</title><sec id="sec007"><title>Patients</title><p>Shimane University Hospital maintains a database of all patients diagnosed as having and hospitalized for mandibular fracture between April 1980 and March 2010. In this study, patients who did not require hospital treatment or had minor injuries were excluded.</p><p>This study was conducted in accordance with the Declaration of Helsinki, and all patient data were unlinked and anonymous. The unlinked anonymity was ensured by the president of Shimane University Faculty of Medicine.</p></sec><sec id="sec008"><title>Evaluated variables</title><p>Patient age, sex, period between injury and first hospital consultation, years since injury, cause of injury, fracture site, treatment mode, and length of hospitalization were evaluated.</p></sec><sec id="sec009"><title>Statistical analysis</title><p>To identify factors associated with the incidence of mandibular fracture, univariate Poisson regression model was performed. The relative risk (RR), the 95% confidence interval (CI) calculated by the Wald test were determined and a likelihood ratio test was conducted for each factor. Fisher’s exact test or Cochran-Armitage test for trend was performed to identify categorical variables associated with age and the Kruskal-Wallis test was used to identify categorical variables associated with period from fracture to first hospital consultation and length of hospitalization. Time periods are expressed as the mean and standard deviation (SD). Here, p<0.05 was considered significant. All statistical analyses were performed using SAS version 9.3 (Cary, NC).</p></sec></sec><sec sec-type="results" id="sec010"><title>Results</title><sec id="sec011"><title>Incidence of mandibular fracture</title><p>Between April 1980 and March 2010, 305 patients were diagnosed with and hospitalized for mandibular fracture at Shimane University Hospital. Both sex (p<0.001) and age (p<0.001) were associated with the incidence of mandibular fracture but decade of injury was not (p = 0.106; <xref rid="pone.0136278.t001" ref-type="table">Table 1</xref>). The incidence of mandibular fracture was higher in males than females (RR: 2.51, 95% CI: 1.95−3.21; <xref rid="pone.0136278.t001" ref-type="table">Table 1</xref>). Younger age increased the risk for mandibular fracture (<xref rid="pone.0136278.t001" ref-type="table">Table 1</xref>).</p><table-wrap id="pone.0136278.t001" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t001</object-id><label>Table 1</label><caption><title>Univariate Poisson regression analysis of mandible fracture incidence in hospitalized patients from Shimane prefecture.</title></caption><alternatives><graphic id="pone.0136278.t001g" xlink:href="pone.0136278.t001"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="left" rowspan="1" colspan="1">Category, n = 305</th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">Relative risk</th><th align="left" rowspan="1" colspan="1">95% CI</th><th align="left" rowspan="1" colspan="1">Likelihood ratiotest</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Decade</td><td align="left" rowspan="1" colspan="1">1980−1990</td><td align="left" rowspan="1" colspan="1">88</td><td align="left" rowspan="1" colspan="1">1.00</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">0.106</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1991−2000</td><td align="left" rowspan="1" colspan="1">118</td><td align="left" rowspan="1" colspan="1">1.34</td><td align="left" rowspan="1" colspan="1">1.02−1.77</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">2001−2010</td><td align="left" rowspan="1" colspan="1">99</td><td align="left" rowspan="1" colspan="1">1.13</td><td align="left" rowspan="1" colspan="1">0.84−1.50</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Sex</td><td align="left" rowspan="1" colspan="1">Female</td><td align="left" rowspan="1" colspan="1">87</td><td align="left" rowspan="1" colspan="1">1.00</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">218</td><td align="left" rowspan="1" colspan="1">2.51</td><td align="left" rowspan="1" colspan="1">1.95−3.21</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Age, years</td><td align="left" rowspan="1" colspan="1">0−19</td><td align="left" rowspan="1" colspan="1">91</td><td align="left" rowspan="1" colspan="1">1.00</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">20−39</td><td align="left" rowspan="1" colspan="1">77</td><td align="left" rowspan="1" colspan="1">0.85</td><td align="left" rowspan="1" colspan="1">0.62−1.15</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">40−59</td><td align="left" rowspan="1" colspan="1">62</td><td align="left" rowspan="1" colspan="1">0.68</td><td align="left" rowspan="1" colspan="1">0.49−0.94</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">60−79</td><td align="left" rowspan="1" colspan="1">59</td><td align="left" rowspan="1" colspan="1">0.65</td><td align="left" rowspan="1" colspan="1">0.47−0.90</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">≥80</td><td align="left" rowspan="1" colspan="1">16</td><td align="left" rowspan="1" colspan="1">0.18</td><td align="left" rowspan="1" colspan="1">0.10−0.30</td><td align="left" rowspan="1" colspan="1"></td></tr></tbody></table></alternatives><table-wrap-foot><fn id="t001fn001"><p>CI: Confidence interval.</p></fn></table-wrap-foot></table-wrap></sec><sec id="sec012"><title>Association between age and sex</title><p>The male to female ratio decreased with age (p<0.001, <xref rid="pone.0136278.t002" ref-type="table">Table 2</xref>) from 5.50, 3.53, and 3.13, respectively, for the youngest groups (0–19, 20–39, 40–59 years) to 1.03 and 0.33 for the oldest two groups (60–79 and ≥80).</p><table-wrap id="pone.0136278.t002" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t002</object-id><label>Table 2</label><caption><title>Association between age and sex.</title></caption><alternatives><graphic id="pone.0136278.t002g" xlink:href="pone.0136278.t002"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="left" rowspan="1" colspan="1">Category, n = 305</th><th align="left" rowspan="1" colspan="1">n</th><th colspan="5" align="left" rowspan="1">Age, n (%)</th><th align="left" rowspan="1" colspan="1">CochranArmitage test</th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">0–19 years,</th><th align="left" rowspan="1" colspan="1">20–39,</th><th align="left" rowspan="1" colspan="1">40–59,</th><th align="left" rowspan="1" colspan="1">60–79,</th><th align="left" rowspan="1" colspan="1">≥80,</th><th align="left" rowspan="1" colspan="1"></th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">n = 91</th><th align="left" rowspan="1" colspan="1">n = 77</th><th align="left" rowspan="1" colspan="1">n = 62</th><th align="left" rowspan="1" colspan="1">n = 59</th><th align="left" rowspan="1" colspan="1">n = 16</th><th align="left" rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Sex</td><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">218</td><td align="left" rowspan="1" colspan="1">77 (84.6)</td><td align="left" rowspan="1" colspan="1">60 (77.9)</td><td align="left" rowspan="1" colspan="1">47 (75.8)</td><td align="left" rowspan="1" colspan="1">30 (50.8)</td><td align="left" rowspan="1" colspan="1">4 (25.0)</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Female</td><td align="left" rowspan="1" colspan="1">87</td><td align="left" rowspan="1" colspan="1">14 (15.4)</td><td align="left" rowspan="1" colspan="1">17 (22.1)</td><td align="left" rowspan="1" colspan="1">15 (24.2)</td><td align="left" rowspan="1" colspan="1">29 (49.2)</td><td align="left" rowspan="1" colspan="1">12 (75.0)</td><td align="left" rowspan="1" colspan="1"></td></tr></tbody></table></alternatives></table-wrap></sec><sec id="sec013"><title>Period from fracture to first hospital consultation</title><p>The median (range) and mean (SD) periods from fracture to first hospital consultation (days) were 1 (0−40) and 2.8 (4.7). Further, the decade was associated with the period from fracture to first hospital consultation (p = 0.004), while sex and age were not (p = 0.830 and p = 0.559, respectively; <xref rid="pone.0136278.t003" ref-type="table">Table 3</xref>). The delay between injury and first hospital consultation decreased progressively with decade from 1980−1990 to 2001−2010 (<xref rid="pone.0136278.t003" ref-type="table">Table 3</xref>).</p><table-wrap id="pone.0136278.t003" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t003</object-id><label>Table 3</label><caption><title>Factor associated with period from fracture to hospital consultation.</title></caption><alternatives><graphic id="pone.0136278.t003g" xlink:href="pone.0136278.t003"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="left" rowspan="1" colspan="1">Category, n = 305</th><th colspan="2" align="left" rowspan="1">Period from fracture to hospital consultation, days</th><th align="left" rowspan="1" colspan="1">Kruskal-Wallis test</th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">Mean</th><th align="left" rowspan="1" colspan="1"></th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">(%)</th><th align="left" rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Decade of</td><td align="left" rowspan="1" colspan="1">1980–1990</td><td align="left" rowspan="1" colspan="1">88</td><td align="left" rowspan="1" colspan="1">4.3 (7.0)</td><td align="left" rowspan="1" colspan="1">0.004</td></tr><tr><td align="left" rowspan="1" colspan="1">injury</td><td align="left" rowspan="1" colspan="1">1991–2000</td><td align="left" rowspan="1" colspan="1">118</td><td align="left" rowspan="1" colspan="1">2.6 (3.5)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">2001–2010</td><td align="left" rowspan="1" colspan="1">99</td><td align="left" rowspan="1" colspan="1">1.6 (2.5)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Sex</td><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">218</td><td align="left" rowspan="1" colspan="1">2.7 (4.9)</td><td align="left" rowspan="1" colspan="1">0.830</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Female</td><td align="left" rowspan="1" colspan="1">87</td><td align="left" rowspan="1" colspan="1">2.8 (4.1)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Age at injury</td><td align="left" rowspan="1" colspan="1">0–19 years</td><td align="left" rowspan="1" colspan="1">91</td><td align="left" rowspan="1" colspan="1">2.4 (4.6)</td><td align="left" rowspan="1" colspan="1">0.599</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">20–39</td><td align="left" rowspan="1" colspan="1">77</td><td align="left" rowspan="1" colspan="1">2.8 (5.1)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">40–59</td><td align="left" rowspan="1" colspan="1">62</td><td align="left" rowspan="1" colspan="1">3.8 (5.6)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">60–79</td><td align="left" rowspan="1" colspan="1">59</td><td align="left" rowspan="1" colspan="1">2.3 (3.2)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">≥80</td><td align="left" rowspan="1" colspan="1">16</td><td align="left" rowspan="1" colspan="1">2.3 (2.7)</td><td align="left" rowspan="1" colspan="1"></td></tr></tbody></table></alternatives></table-wrap></sec><sec id="sec014"><title>Cause of mandibular fracture</title><p>Both age and sex were associated with the cause of mandibular fracture (both p<0.001; <xref rid="pone.0136278.t004" ref-type="table">Table 4</xref>). Fall was a more common cause in those aged ≥60 years than in those aged <60 years (chi-squared test: p<0.001; <xref rid="pone.0136278.t004" ref-type="table">Table 4</xref>). Fall caused the majority of mandibular fractures in patients 70−79 years old and was the only cause reported in patients ≥80 years old. Traffic accidents were a more frequent cause in males than females for all age groups except for those aged ≥80 years (no cases). Males accounted for almost all sports accidents, and all cases (both male and female) were aged <40 years (<xref rid="pone.0136278.t004" ref-type="table">Table 4</xref>). Males also accounted for the vast majority of work-related mandibular fractures, and almost 60% occurred in the 40−59 age group (<xref rid="pone.0136278.t004" ref-type="table">Table 4</xref>). Finally, males accounted for most cases of violence-related mandibular fracture, almost all in males younger than 40 years. All violence-related cases, both male and female, were patients aged <60 years (<xref rid="pone.0136278.t004" ref-type="table">Table 4</xref>).</p><table-wrap id="pone.0136278.t004" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t004</object-id><label>Table 4</label><caption><title>Causes of fracture stratified by sex and age.</title></caption><alternatives><graphic id="pone.0136278.t004g" xlink:href="pone.0136278.t004"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="left" rowspan="1" colspan="1">Category, n = 305</th><th align="left" rowspan="1" colspan="1">n</th><th colspan="6" align="left" rowspan="1">Causes of fracture, n (%)</th><th align="left" rowspan="1" colspan="1">Fisher's exact test</th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">Fall, n = 113</th><th align="left" rowspan="1" colspan="1">Traffic accident, n = 91</th><th align="left" rowspan="1" colspan="1">Sports accident, n = 39</th><th align="left" rowspan="1" colspan="1">Work related, n = 30</th><th align="left" rowspan="1" colspan="1">Violence, n = 29</th><th align="left" rowspan="1" colspan="1">Others, n = 3</th><th align="left" rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Sex</td><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">218</td><td align="left" rowspan="1" colspan="1">63 (55.8)</td><td align="left" rowspan="1" colspan="1">59 (64.8)</td><td align="left" rowspan="1" colspan="1">38 (97.4)</td><td align="left" rowspan="1" colspan="1">29 (96.7)</td><td align="left" rowspan="1" colspan="1">26 (89.7)</td><td align="left" rowspan="1" colspan="1">3 (100.0)</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Female</td><td align="left" rowspan="1" colspan="1">87</td><td align="left" rowspan="1" colspan="1">50 (44.2)</td><td align="left" rowspan="1" colspan="1">32 (35.2)</td><td align="left" rowspan="1" colspan="1">1 (2.6)</td><td align="left" rowspan="1" colspan="1">1 (3.3)</td><td align="left" rowspan="1" colspan="1">3 (10.3)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Age</td><td align="left" rowspan="1" colspan="1">0–19 years</td><td align="left" rowspan="1" colspan="1">91</td><td align="left" rowspan="1" colspan="1">23 (20.4)</td><td align="left" rowspan="1" colspan="1">29 (31.9)</td><td align="left" rowspan="1" colspan="1">27 (69.2)</td><td align="left" rowspan="1" colspan="1">3 (10.0)</td><td align="left" rowspan="1" colspan="1">9 (31.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">20–39</td><td align="left" rowspan="1" colspan="1">77</td><td align="left" rowspan="1" colspan="1">16 (14.2)</td><td align="left" rowspan="1" colspan="1">26 (28.6)</td><td align="left" rowspan="1" colspan="1">12 (30.8)</td><td align="left" rowspan="1" colspan="1">6 (20.0)</td><td align="left" rowspan="1" colspan="1">16 (55.2)</td><td align="left" rowspan="1" colspan="1">1 (33.3)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">40–59</td><td align="left" rowspan="1" colspan="1">62</td><td align="left" rowspan="1" colspan="1">20 (17.7)</td><td align="left" rowspan="1" colspan="1">20 (22.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">17 (56.7)</td><td align="left" rowspan="1" colspan="1">4 (13.8)</td><td align="left" rowspan="1" colspan="1">1 (33.3)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">60–79</td><td align="left" rowspan="1" colspan="1">59</td><td align="left" rowspan="1" colspan="1">38 (33.6)</td><td align="left" rowspan="1" colspan="1">16 (17.6)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">4 (13.3)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (33.3)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">≥80</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">16 (14.2)</td><td align="center" rowspan="1" colspan="1">0 (0.0)</td><td align="center" rowspan="1" colspan="1">0 (0.0)</td><td align="center" rowspan="1" colspan="1">0 (0.0)</td><td align="center" rowspan="1" colspan="1">0 (0.0)</td><td align="center" rowspan="1" colspan="1">0 (0.0)</td><td align="center" rowspan="1" colspan="1"></td></tr></tbody></table></alternatives></table-wrap></sec><sec id="sec015"><title>Site of mandibular fracture</title><p>In the 305 patients hospitalized for mandible fracture, 274 (89.8%) had mandibular fracture only, while 25 cases (8.2%) were accompanied by maxilla fracture, 3 (1.0%) by zygoma fracture, and 3 (1.0%) by maxilla and zygoma fractures. In both sexes, the condyle was the most common fracture site (126 cases, 41.3%), followed by the symphysis (114, 37.4%), angle (82, 26.9%), body (41, 13.4%), alveolar process (28, 9.2%), and ramus (6, 2.0%). The facture site was associated with sex for condyle (p = 0.003), symphysis (p = 0.013), and angle (p = 0.022), but not for the body, alveolar process, or ramus (p = 0.710, p = 0.083, and p = 0.188, respectively; <xref rid="pone.0136278.t005" ref-type="table">Table 5</xref>). The facture site was also associated with age for the condyle and angle (both p<0.001) and the symphysis (p = 0.001) but not for the ramus, body, or alveolar process (p = 0.818, 0.049, and p = 0.568, respectively; <xref rid="pone.0136278.t006" ref-type="table">Table 6</xref>). Furthermore, fracture at the condyle, angle, and alveolar process was associated with surgical/non-surgical treatment (p = 0.047, p = 0.004, and p<0.001, respectively), while fracture of the ramus or body was not (p = 0.526 and p = 0.300, respectively; <xref rid="pone.0136278.t007" ref-type="table">Table 7</xref>). Fractures sites in cases of multiple mandibular fractures are shown in <xref rid="pone.0136278.t008" ref-type="table">Table 8</xref>.</p><table-wrap id="pone.0136278.t005" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t005</object-id><label>Table 5</label><caption><title>Site of mandible fracture stratified by sex.</title></caption><alternatives><graphic id="pone.0136278.t005g" xlink:href="pone.0136278.t005"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Site of mandible fracture, n = 305</th><th align="left" rowspan="1" colspan="1">n</th><th colspan="2" align="left" rowspan="1">Sex, n (%)</th><th align="left" rowspan="1" colspan="1">Fisher's exact test</th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">Male, n = 218</th><th align="left" rowspan="1" colspan="1">Female, n = 87</th><th align="left" rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Condyle</td><td align="left" rowspan="1" colspan="1">126</td><td align="left" rowspan="1" colspan="1">78 (35.8)</td><td align="left" rowspan="1" colspan="1">48 (55.2)</td><td align="left" rowspan="1" colspan="1">0.003</td></tr><tr><td align="left" rowspan="1" colspan="1">Ramus</td><td align="left" rowspan="1" colspan="1">6</td><td align="left" rowspan="1" colspan="1">6 (2.8)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0.188</td></tr><tr><td align="left" rowspan="1" colspan="1">Angle</td><td align="left" rowspan="1" colspan="1">82</td><td align="left" rowspan="1" colspan="1">67 (30.7)</td><td align="left" rowspan="1" colspan="1">15 (17.2)</td><td align="left" rowspan="1" colspan="1">0.022</td></tr><tr><td align="left" rowspan="1" colspan="1">Body</td><td align="left" rowspan="1" colspan="1">41</td><td align="left" rowspan="1" colspan="1">28 (12.8)</td><td align="left" rowspan="1" colspan="1">13 (14.9)</td><td align="left" rowspan="1" colspan="1">0.710</td></tr><tr><td align="left" rowspan="1" colspan="1">Symphysis</td><td align="left" rowspan="1" colspan="1">114</td><td align="left" rowspan="1" colspan="1">91 (41.7)</td><td align="left" rowspan="1" colspan="1">23 (26.4)</td><td align="left" rowspan="1" colspan="1">0.013</td></tr><tr><td align="left" rowspan="1" colspan="1">Alveolar process</td><td align="left" rowspan="1" colspan="1">28</td><td align="left" rowspan="1" colspan="1">16 (7.3)</td><td align="left" rowspan="1" colspan="1">12 (13.8)</td><td align="left" rowspan="1" colspan="1">0.083</td></tr></tbody></table></alternatives></table-wrap><table-wrap id="pone.0136278.t006" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t006</object-id><label>Table 6</label><caption><title>Site of mandible fracture stratified by age.</title></caption><alternatives><graphic id="pone.0136278.t006g" xlink:href="pone.0136278.t006"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Site of mandible fracture, n = 305</th><th align="left" rowspan="1" colspan="1">n</th><th colspan="5" align="left" rowspan="1">Age, n (%)</th><th align="left" rowspan="1" colspan="1">Cochran-Armitage test</th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">0–19 years, n = 91</th><th align="left" rowspan="1" colspan="1">20–39, n = 77</th><th align="left" rowspan="1" colspan="1">40–59, n = 62</th><th align="left" rowspan="1" colspan="1">60–79, n = 59</th><th align="left" rowspan="1" colspan="1">≥80, n = 16</th><th align="left" rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Condyle</td><td align="left" rowspan="1" colspan="1">126</td><td align="left" rowspan="1" colspan="1">26 (28.6)</td><td align="left" rowspan="1" colspan="1">26 (33.8)</td><td align="left" rowspan="1" colspan="1">29 (46.8)</td><td align="left" rowspan="1" colspan="1">35 (59.3)</td><td align="left" rowspan="1" colspan="1">10 (62.5)</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Ramus</td><td align="left" rowspan="1" colspan="1">6</td><td align="left" rowspan="1" colspan="1">1 (1.1)</td><td align="left" rowspan="1" colspan="1">2 (2.6)</td><td align="left" rowspan="1" colspan="1">3 (4.8)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0.818</td></tr><tr><td align="left" rowspan="1" colspan="1">Angle</td><td align="left" rowspan="1" colspan="1">82</td><td align="left" rowspan="1" colspan="1">32 (35.2)</td><td align="left" rowspan="1" colspan="1">28 (36.4)</td><td align="left" rowspan="1" colspan="1">12 (19.4)</td><td align="left" rowspan="1" colspan="1">9 (15.3)</td><td align="left" rowspan="1" colspan="1">1 (6.3)</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Body</td><td align="left" rowspan="1" colspan="1">41</td><td align="left" rowspan="1" colspan="1">8 (8.8)</td><td align="left" rowspan="1" colspan="1">11 (14.3)</td><td align="left" rowspan="1" colspan="1">7 (11.3)</td><td align="left" rowspan="1" colspan="1">11 (18.6)</td><td align="left" rowspan="1" colspan="1">4 (25.0)</td><td align="left" rowspan="1" colspan="1">0.049</td></tr><tr><td align="left" rowspan="1" colspan="1">Symphysis</td><td align="left" rowspan="1" colspan="1">114</td><td align="left" rowspan="1" colspan="1">42 (46.2)</td><td align="left" rowspan="1" colspan="1">31 (40.3)</td><td align="left" rowspan="1" colspan="1">27 (43.5)</td><td align="left" rowspan="1" colspan="1">11 (18.6)</td><td align="left" rowspan="1" colspan="1">3 (18.8)</td><td align="left" rowspan="1" colspan="1">0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Alveolar process</td><td align="left" rowspan="1" colspan="1">28</td><td align="left" rowspan="1" colspan="1">11 (12.1)</td><td align="left" rowspan="1" colspan="1">4 (5.2)</td><td align="left" rowspan="1" colspan="1">6 (9.7)</td><td align="left" rowspan="1" colspan="1">7 (11.9)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0.568</td></tr></tbody></table></alternatives></table-wrap><table-wrap id="pone.0136278.t007" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t007</object-id><label>Table 7</label><caption><title>Site of mandible fracture stratified by treatment.</title></caption><alternatives><graphic id="pone.0136278.t007g" xlink:href="pone.0136278.t007"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th colspan="2" align="left" rowspan="1">Treatment, n (%)</th><th align="left" rowspan="1" colspan="1"></th></tr><tr><th align="left" rowspan="1" colspan="1">Site of mandible fracture, n = 305</th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">Surgical, n = 102</th><th align="left" rowspan="1" colspan="1">Non-surgical, n = 203</th><th align="left" rowspan="1" colspan="1">Fisher's exact test</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Condyle</td><td align="left" rowspan="1" colspan="1">126</td><td align="left" rowspan="1" colspan="1">33 (32.4)</td><td align="left" rowspan="1" colspan="1">93 (45.8)</td><td align="left" rowspan="1" colspan="1">0.047</td></tr><tr><td align="left" rowspan="1" colspan="1">Ramus</td><td align="left" rowspan="1" colspan="1">6</td><td align="left" rowspan="1" colspan="1">3 (2.9)</td><td align="left" rowspan="1" colspan="1">3 (1.5)</td><td align="left" rowspan="1" colspan="1">0.526</td></tr><tr><td align="left" rowspan="1" colspan="1">Angle</td><td align="left" rowspan="1" colspan="1">82</td><td align="left" rowspan="1" colspan="1">17 (16.7)</td><td align="left" rowspan="1" colspan="1">65 (32)</td><td align="left" rowspan="1" colspan="1">0.004</td></tr><tr><td align="left" rowspan="1" colspan="1">Body</td><td align="left" rowspan="1" colspan="1">41</td><td align="left" rowspan="1" colspan="1">18 (17.6)</td><td align="left" rowspan="1" colspan="1">23 (11.3)</td><td align="left" rowspan="1" colspan="1">0.300</td></tr><tr><td align="left" rowspan="1" colspan="1">Symphysis</td><td align="left" rowspan="1" colspan="1">114</td><td align="left" rowspan="1" colspan="1">44 (43.1)</td><td align="left" rowspan="1" colspan="1">70 (34.5)</td><td align="left" rowspan="1" colspan="1">0.232</td></tr><tr><td align="left" rowspan="1" colspan="1">Alveolar process</td><td align="left" rowspan="1" colspan="1">28</td><td align="left" rowspan="1" colspan="1">23 (22.5)</td><td align="left" rowspan="1" colspan="1">5 (2.5)</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr></tbody></table></alternatives></table-wrap><table-wrap id="pone.0136278.t008" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t008</object-id><label>Table 8</label><caption><title>Site of mandible fracture.</title></caption><alternatives><graphic id="pone.0136278.t008g" xlink:href="pone.0136278.t008"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Site of mandible fracture, n = 305</th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">%</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Condyle</td><td align="left" rowspan="1" colspan="1">63</td><td align="left" rowspan="1" colspan="1">20.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Condyle + ramus</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">0.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Condyle + angle</td><td align="left" rowspan="1" colspan="1">9</td><td align="left" rowspan="1" colspan="1">3</td></tr><tr><td align="left" rowspan="1" colspan="1">Condyle + angle + symphysis</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">0.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Condyle + body</td><td align="left" rowspan="1" colspan="1">11</td><td align="left" rowspan="1" colspan="1">3.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Condyle + symphysis</td><td align="left" rowspan="1" colspan="1">40</td><td align="left" rowspan="1" colspan="1">13.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Condyle + symphysis + alveolar process</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">0.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Ramus + angle + symphysis</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">0.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Ramus + symphysis</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">1.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Angle</td><td align="left" rowspan="1" colspan="1">37</td><td align="left" rowspan="1" colspan="1">12.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Angle + body</td><td align="left" rowspan="1" colspan="1">6</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1">Angle + body + symphysis</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">0.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Angle + symphysis</td><td align="left" rowspan="1" colspan="1">27</td><td align="left" rowspan="1" colspan="1">8.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Body</td><td align="left" rowspan="1" colspan="1">14</td><td align="left" rowspan="1" colspan="1">4.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Body + symphysis</td><td align="left" rowspan="1" colspan="1">9</td><td align="left" rowspan="1" colspan="1">3</td></tr><tr><td align="left" rowspan="1" colspan="1">Symphysis</td><td align="left" rowspan="1" colspan="1">28</td><td align="left" rowspan="1" colspan="1">9.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Symphysis + alveolar process</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">0.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Alveolar process</td><td align="left" rowspan="1" colspan="1">25</td><td align="left" rowspan="1" colspan="1">8.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Unknown</td><td align="left" rowspan="1" colspan="1">25</td><td align="left" rowspan="1" colspan="1">8.2</td></tr></tbody></table></alternatives></table-wrap></sec><sec id="sec016"><title>Treatment for mandibular fracture</title><p>The treatments provided are summarized in <xref rid="pone.0136278.t009" ref-type="table">Table 9</xref>. The most common surgical procedure was insertion of a titanium plate. About two-thirds of patients were treated conservatively, mainly by intermaxillary fixation.</p><table-wrap id="pone.0136278.t009" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t009</object-id><label>Table 9</label><caption><title>Treatment for mandible fracture.</title></caption><alternatives><graphic id="pone.0136278.t009g" xlink:href="pone.0136278.t009"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th colspan="2" align="left" rowspan="1">Treatment, n = 305</th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">%</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Surgical</td><td align="left" rowspan="1" colspan="1">Titanium plate</td><td align="left" rowspan="1" colspan="1">52</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Teeth ligation</td><td align="left" rowspan="1" colspan="1">13</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Absorbable plate</td><td align="left" rowspan="1" colspan="1">12</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Other</td><td align="left" rowspan="1" colspan="1">12</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Titanium plate and other</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Kirschner wire</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Bone depletion</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">(Missing)</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">total</td><td align="left" rowspan="1" colspan="1">102</td><td align="left" rowspan="1" colspan="1">33.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Conservative</td><td align="left" rowspan="1" colspan="1">Intermaxillary fixation</td><td align="left" rowspan="1" colspan="1">146</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Chin cap</td><td align="left" rowspan="1" colspan="1">24</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Elastic vantage</td><td align="left" rowspan="1" colspan="1">23</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">total</td><td align="left" rowspan="1" colspan="1">193</td><td align="left" rowspan="1" colspan="1">63.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Others</td><td align="left" rowspan="1" colspan="1">No treatment</td><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">(Missing)</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">total</td><td align="left" rowspan="1" colspan="1">10</td><td align="left" rowspan="1" colspan="1">3.3</td></tr></tbody></table></alternatives></table-wrap></sec><sec id="sec017"><title>Factor associated with length of hospitalization</title><p>The median (min−max) and mean (SD) length of hospitalization (days) were 23 (3−88) and 26.0 (14.6). Both decade of injury and age were associated with length of hospitalization (both p<0.001), while sex and treatment with/without surgical were not (p = 0.452 and p = 0.124; <xref rid="pone.0136278.t010" ref-type="table">Table 10</xref>). Length of hospitalization decreased progressively from 1980−1990 to 2001−2010 (<xref rid="pone.0136278.t010" ref-type="table">Table 10</xref>). Length was longer in the 20−39 and 40−59 year age groups (<xref rid="pone.0136278.t010" ref-type="table">Table 10</xref>).</p><table-wrap id="pone.0136278.t010" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0136278.t010</object-id><label>Table 10</label><caption><title>Factors associated with length of hospitalization.</title></caption><alternatives><graphic id="pone.0136278.t010g" xlink:href="pone.0136278.t010"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="left" rowspan="1" colspan="1">Category, n = 305</th><th colspan="2" align="left" rowspan="1">Length of hospitalization, days</th><th align="left" rowspan="1" colspan="1">Kruskal-Wallis test</th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">Mean (standard deviation)</th><th align="left" rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Decade</td><td align="left" rowspan="1" colspan="1">1980–1990</td><td align="left" rowspan="1" colspan="1">88</td><td align="left" rowspan="1" colspan="1">31.5 (15.8)</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1991–2000</td><td align="left" rowspan="1" colspan="1">118</td><td align="left" rowspan="1" colspan="1">27.1 (14.3)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">2001–2010</td><td align="left" rowspan="1" colspan="1">99</td><td align="left" rowspan="1" colspan="1">19.8 (11.4)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Sex</td><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">218</td><td align="left" rowspan="1" colspan="1">25.6 (15.4)</td><td align="left" rowspan="1" colspan="1">0.452</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Female</td><td align="left" rowspan="1" colspan="1">87</td><td align="left" rowspan="1" colspan="1">26.2 (14.3)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Age,</td><td align="left" rowspan="1" colspan="1">0−19 years</td><td align="left" rowspan="1" colspan="1">91</td><td align="left" rowspan="1" colspan="1">21.7 (11.5)</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">years</td><td align="left" rowspan="1" colspan="1">20−39</td><td align="left" rowspan="1" colspan="1">77</td><td align="left" rowspan="1" colspan="1">28.4 (15.7)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">40−59</td><td align="left" rowspan="1" colspan="1">62</td><td align="left" rowspan="1" colspan="1">32.2 (16.5)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">60−79</td><td align="left" rowspan="1" colspan="1">59</td><td align="left" rowspan="1" colspan="1">24.7 (13.7)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">≥80</td><td align="left" rowspan="1" colspan="1">16</td><td align="left" rowspan="1" colspan="1">19.8 (11.3)</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Therapy</td><td align="left" rowspan="1" colspan="1">Surgical</td><td align="left" rowspan="1" colspan="1">102</td><td align="left" rowspan="1" colspan="1">28.2 (16.1)</td><td align="left" rowspan="1" colspan="1">0.124</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Non-surgical</td><td align="left" rowspan="1" colspan="1">193</td><td align="left" rowspan="1" colspan="1">24.9 (13.8)</td><td align="left" rowspan="1" colspan="1"></td></tr></tbody></table></alternatives></table-wrap></sec></sec><sec sec-type="conclusions" id="sec018"><title>Discussion</title><p>This study revealed that incidence of mandibular fracture was highest in younger patients, especially in males, in accord with previous studies [<xref rid="pone.0136278.ref009" ref-type="bibr">9</xref>–<xref rid="pone.0136278.ref012" ref-type="bibr">12</xref>]. However, unlike previous reports, the number of the patients aged ≥60 years in our study population was strikingly high at 24.6%, compared to only 3.0% and 6.3% in studies of other regions [<xref rid="pone.0136278.ref013" ref-type="bibr">13</xref>, <xref rid="pone.0136278.ref014" ref-type="bibr">14</xref>]. Moreover, several previous studies reported that only 3.2%−10.0% of patients with mandibular fracture were ≥50 years old [<xref rid="pone.0136278.ref009" ref-type="bibr">9</xref>–<xref rid="pone.0136278.ref011" ref-type="bibr">11</xref>], again substantially lower than in our department. Thus, the epidemiology of mandibular fracture is expected to differ among regions, depending on demographic make-up (percentage of elderly), and may be more common in aging populations than indicated in previous studies.</p><p>Mandibular fracture occurs more frequently in males [<xref rid="pone.0136278.ref010" ref-type="bibr">10</xref>–<xref rid="pone.0136278.ref017" ref-type="bibr">17</xref>], with male to female ratios ranging from 2.3:1 to 7.4:1 [<xref rid="pone.0136278.ref015" ref-type="bibr">15</xref>, <xref rid="pone.0136278.ref017" ref-type="bibr">17</xref>], so the ratio found in our department for the entire patient group (2.5:1) falls within this range, albeit on the lower end. Other studies have reported lower ratios in old patients, such as 1.1:1 in patients aged ≥60 years [<xref rid="pone.0136278.ref001" ref-type="bibr">1</xref>], comparable to the 0.8:1 calculated here. Thus, the ratio of male to female patients treated is expected to change depending on the proportion of elderly residents in the population. Indeed, the oldest patients treated in Shimane prefecture were female (<xref rid="pone.0136278.t002" ref-type="table">Table 2</xref>) [<xref rid="pone.0136278.ref007" ref-type="bibr">7</xref>].</p><p>The period until first hospital consultation has decreased in our department over the study period, possibly due to the development of more accessible transportation and establishment of an emergency system. In many studies, the most common cause of mandibular fracture was traffic accidents [<xref rid="pone.0136278.ref010" ref-type="bibr">10</xref>–<xref rid="pone.0136278.ref012" ref-type="bibr">12</xref>, <xref rid="pone.0136278.ref014" ref-type="bibr">14</xref>, <xref rid="pone.0136278.ref016" ref-type="bibr">16</xref>, <xref rid="pone.0136278.ref018" ref-type="bibr">18</xref>], although some studies have reported assault or other forms of violence to be the most common cause [<xref rid="pone.0136278.ref009" ref-type="bibr">9</xref>, <xref rid="pone.0136278.ref013" ref-type="bibr">13</xref>, <xref rid="pone.0136278.ref017" ref-type="bibr">17</xref>]. In our department, the most common cause of fractures was fall (n = 113), and in almost half of all cases (n = 54). However, among patients aged <60 years, traffic accidents (n = 75) was the single most common cause. Similarly, a previous study [<xref rid="pone.0136278.ref001" ref-type="bibr">1</xref>] reported that falls was the most common cause (43.5%) in patients aged ≥60 years. Moreover, another study [<xref rid="pone.0136278.ref019" ref-type="bibr">19</xref>] reported that facial injuries caused by falls were more common among elderly women with limited mobility and osteoporosis.</p><p>The most common site of mandibular fractures manifested in our department was the condyle, followed by the symphysis and angle, and fractures at these locations were associated with age. In general, the most common sites of mandibular fracture are the condyle and angle (especially in the presence of an impacted or semi-erupted third molar), mental foramen or body, parasymphysis, and any part of the dental alveolus [<xref rid="pone.0136278.ref020" ref-type="bibr">20</xref>]. However, the most common fracture site in patients aged ≥60 years in this study group was the symphysis, followed by the body. Although the reason for this is unclear, it is possible that elderly patients with limited mobility, especially those living alone, can easily stumble and fall, striking their mandible against the ground directly without first falling into outstretched hands or arms, causing an indirect fracture of the condyle. In addition, it is also possible that dentition is associated with mandibular fractures in the elderly because they are often fully or partially edentulous, with atrophy of the jaw and osteoporosis [<xref rid="pone.0136278.ref019" ref-type="bibr">19</xref>].</p><p>In this study, fracture with condylar, angle, or alveolar involvement was also associated with treatment with/without surgery. More than half of all patients were treated with intermaxillary fixation, chin cap, elastic bandage, or other conservative treatment. In our department, conservative treatment is usually applied first, especially for condylar fractures. Our previous studies [<xref rid="pone.0136278.ref021" ref-type="bibr">21</xref>, <xref rid="pone.0136278.ref022" ref-type="bibr">22</xref>] revealed that mandibular condylar fracture healing was delayed by aging, and thus a conservative treatment approach is more feasible for younger patients. However, a number of surgical procedures for mandibular condylar fractures have been reported using less invasive endoscopy [<xref rid="pone.0136278.ref023" ref-type="bibr">23</xref>], fixation by a mini-plate [<xref rid="pone.0136278.ref024" ref-type="bibr">24</xref>], and the retromandibular approach [<xref rid="pone.0136278.ref025" ref-type="bibr">25</xref>].</p><p>In our department, we also apply conservative treatment for mandibular angle fracture. As this fracture is most common in younger patients with healthy teeth, intermaxillary fixation is usually indicated. However, bony synthesis can take a long time, so surgical treatment methods are becoming more common in our department. On the other hand, mandibular alveolar fracture was treated surgically because it requires teeth ligation with reduction of deviated alveolar ridge.</p><p>In recent years, surgical approaches using computer-assisted navigation have been developed [<xref rid="pone.0136278.ref026" ref-type="bibr">26</xref>], and CAD/CAM machines can instantly produce plates [<xref rid="pone.0136278.ref027" ref-type="bibr">27</xref>, <xref rid="pone.0136278.ref028" ref-type="bibr">28</xref>]. As more elderly patients require treatment for mandibular fracture, we must determine how best to treat this group.</p></sec><sec sec-type="conclusions" id="sec019"><title>Conclusions</title><p>In our department, patients aged ≥60 years accounted for a greater proportion of mandibular fracture cases than in many previous studies, reflecting the greater proportion of elderly residents in Shimane prefecture.</p></sec><sec sec-type="supplementary-material" id="sec020"><title>Supporting Information</title><supplementary-material content-type="local-data" id="pone.0136278.s001"><label>S1 Checklist</label><caption><title>Our paper adheres to the STROBE guidelines for the reporting of observational studies in epidemiology.</title><p>We completed STROBE checklist as an additional file.</p><p>(DOC)</p></caption><media xlink:href="pone.0136278.s001.doc"><caption><p>Click here for additional data file.</p></caption></media></supplementary-material></sec></body><back><ack><p>Translational research Informatics Center did not commit process of the data collection in this research. 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