Analysis of jaw fractures in motorcycle accidents: a systematic review

Article information

Arch Craniofac Surg. 2025;26(3):85-91

Publication date (electronic) : 2025 June 20

doi : https://doi.org/10.7181/acfs.2025.0008

Andi Muhammad Arif¹, Andi Tajrin², Nurwahida²

¹Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia

²Department of Oral and Maxillofacial Surgery, Dental Hospital of Hasanuddin University, Makassar, Indonesia

Correspondence: Andi Tajrin, Department of Oral and Maxillofacial Surgery, Dental Hospital of Hasanuddin University, Jalan Perintis Kemerdekaan Km.10, Makassar 90245, Indonesia, E-mail: anditajrin@unhas.ac.id

Received 2025 February 8; Revised 2025 April 10; Accepted 2025 June 3.

Abstract

INTRODUCTION

Maxillofacial trauma refers to injuries of the facial bones and surrounding soft and hard tissues. Due to the complexity of the craniofacial anatomy, such trauma can present in various forms, including skin abrasions, puncture wounds, lacerations, nerve damage, gland injuries, and tooth and bone fractures. Temporomandibular joint injuries, vascular damage, and muscle trauma may also accompany mandibular fractures. The anterior facial region serves as a protective barrier for the cranium and is critical for both appearance and essential functions, such as vision, olfaction, mastication, respiration, and speech [1–4].

Motorcycle accidents contribute significantly to maxillofacial trauma, with mandibular fractures among the most frequently reported injuries. Traffic collisions not only impose financial burdens but also cause a spectrum of physical harm, from minor wounds to life threatening conditions. Epidemiological studies indicate that motorcyclists are especially vulnerable to maxillofacial injuries due to the absence of protective structures, such as seat belts and airbags, that are standard in enclosed vehicles. According to the Hurt Report, 98% of multi vehicle motorcycle collisions and 96% of single vehicle crashes result in injury, with 45% of riders sustaining more than minor trauma. Reports suggest that maxillofacial injuries account for approximately 10% to 30% of all emergency trauma cases, underscoring the seriousness of the issue [5–8].

Several studies have examined the associations among trauma severity indices, treatment costs, and length of hospitalization. However, comprehensive analyses exploring how injury severity correlates with post accident complications, particularly in cases involving mandibular fractures, remain limited [9,10]. Understanding these relationships is essential for developing effective prevention strategies, optimizing treatment protocols, and minimizing long-term complications. The high incidence of facial fractures among motorcyclists underscores the need for enhanced safety measures, such as improvements in helmet usage, stricter traffic regulations, and public education focused on road safety.

This review was performed to analyze the patterns and implications of mandibular fractures resulting from motorcycle accidents. By addressing existing research gaps, presenting epidemiological data, and emphasizing clinical and research significance, this study seeks to contribute to improved patient outcomes and inform policy measures designed to reduce motorcycle related maxillofacial trauma.

METHODS

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to ensure transparency and reproducibility in study selection [11]. We applied the PICO framework to refine our search strategy and enhance the quality of literature retrieval [12]. A comprehensive literature search was conducted across four major electronic databases: Web of Science, PubMed, Embase, and Google Scholar. The search strategy was developed using the Population, Intervention, Comparison, Outcome framework and employed relevant Medical Subject Headings combined with Boolean operators (AND, OR) to refine the results (Table 1) [13,14].

Table 1

Search strategy

The Scottish Intercollegiate Guidelines Network recommendation classification system was applied to assess confidence in the evidence and the strength of the recommendations. Based on this framework for medical or health guidelines, clinicians can obtain clear guidance for decision-making based on the level of confidence in the evidence. This also helps reduce the risk of bias and improves the quality of the articles included in a systematic review (Tables 2, 3).

Table 2

Scottish Intercollegiate Guidelines Network (SIGN) criteria

Table 3

Risk of bias of included studies

RESULTS AND DISCUSSION

The systematic search identified 1,900 articles. After the application of predefined inclusion and exclusion criteria, six articles remained for detailed analysis (Fig. 1). These studies, with their risk of bias detailed in Table 3, were the most pertinent to our objectives. Their data are summarized in Table 4.

Fig. 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flowchart of the study selection process for this systematic review.

Table 4

Characteristics of included studies

Cabral et al. [14] reported that of 171 cases of mandibular condylar fractures, most patients were young male motorcyclists, with sub condylar fractures being the most prevalent type. Statistical analysis demonstrated that surgical intervention significantly reduced the risk of complications (by 49% compared to non-surgical management), with particular effects in preserving jaw function and facial nerve integrity [15–17]. Similarly, Chuang et al. [18] conducted a study of 881 patients in Taiwan and found that children were more susceptible to mandibular fractures, whereas elderly patients more often sustained concomitant head trauma. The overall mortality rate in their study was 3.1%. Facial fracture patterns among motorcyclists varied significantly by age (p<0.01), highlighting the necessity of age-specific trauma management strategies [18–20]. A significant association was found between traumatic brain injury and fractures of the zygomatic arch, Le Fort II, maxilla, nose, and mandible (p<0.05) [4]. These findings reinforce the concept that certain facial fracture patterns may serve as clinical indicators of severe brain injury, underscoring the importance of early screening and timely intervention to improve prognosis (Table 5) [4,5,15,20].

Table 5

Characteristics of included studies, continued

In line with these findings, Natigor et al. [5] investigated the relationship between mandibular fracture location and intracranial injury, revealing that mandibular symphysis fractures, including those sustained in motorcycle accidents, carried a significantly higher risk of intracranial lesions than fractures in other mandibular regions. These findings suggest that mandibular fracture patterns could serve as valuable predictors of intracranial trauma, supporting the incorporation of fracture site assessment into initial trauma evaluations.

The role of helmet use in reducing the severity of mandibular fractures was also extensively analyzed. Multiple studies demonstrated that full-face helmets significantly reduced the incidence of condylar and symphyseal fractures, whereas riders wearing half face or open face helmets had a 2.5 fold higher risk of severe mandibular fractures (Abbreviated Injury Scale ≥3) compared to full face helmet users [4,6,9,15,17,20]. Non helmeted riders exhibited a significantly higher rate of comminuted fractures, necessitating surgical fixation and longer recovery periods. Overall, helmet use was associated with a 40% reduction in trauma severity, a decrease in hospitalization duration by a mean of 2 to 3 days, and a lower likelihood of requiring surgery, particularly in low-impact collisions. In Indonesia, traffic accidents—particularly those involving motorcycles—remain a leading cause of traumatic injuries, including mandibular fractures. Data from the Indonesian National Traffic Police Corps (Korlantas Polri) indicate that motorcycles account for more than 70% of all traffic accident cases annually [21]. The primary regulation governing traffic safety in Indonesia is Law No. 22 of 2009 concerning Road Traffic and Transportation, which mandates helmet use and sets vehicle safety standards [22]. However, compliance with these regulations varies widely and tends to be suboptimal in certain regions, particularly in rural and remote areas. This issue is exacerbated by inconsistent law enforcement and inadequate traffic infrastructure such as poor street lighting, unregulated intersections, and uneven distribution of emergency trauma response systems.

Furthermore, the absence of a unified national trauma registry hinders the collection of real-time data critical for monitoring and managing maxillofacial injuries resulting from traffic accidents [21]. Environmental factors including poor road conditions, traffic congestion, and lack of safety education have been identified as significant contributors to the high incidence of accidents [23]. Although Law No. 22/2009 serves as the primary legal framework, its regional implementation and safety campaigns remain inconsistent and have not reached all community levels effectively [24].

While these findings underscore the protective benefit of full-face helmets, further research is warranted to evaluate long-term functional outcomes across helmet types in preventing maxillofacial trauma.

Beyond individual risk factors, age and geographic setting also influenced mandibular fracture patterns. Young adults (20 to 40 years old) accounted for the greatest proportion of fractures, aligning with higher motorcycle usage in this demographic. In contrast, patients over 60 years experienced more complex fractures, attributed to lower bone density and a higher rate of comorbidities, which resulted in an increased risk of complications. Additionally, urban areas exhibited higher rates of symphyseal and para-symphyseal fractures, likely due to their relative propensity for high-speed collisions and denser traffic conditions, whereas rural regions recorded more condylar fractures, perhaps linked to poorer road infrastructure and lower helmet compliance. These findings suggest that preventive strategies should be tailored to age and regional contexts, including mandatory full face helmet laws, enhanced road safety measures, and specialized trauma care protocols for high risk populations.

Environmental and behavioral factors further contributed to the incidence and severity of mandibular fractures in motorcycle accidents. Excessive speed correlated directly with higher trauma severity, underscoring the need for strict speed regulations. Similarly, poor road conditions and inadequate nighttime lighting—especially in rural areas—significantly increased the likelihood of accidents. Helmet law compliance was also lower among low-income and rural populations, highlighting the need for targeted public safety campaigns to promote helmet use. Although helmets are a proven protective measure, the persistence of severe mandibular fractures in high speed collisions warrants further study. Infrastructure improvements and enhanced public awareness programs could further reduce the incidence of motorcycle-related maxillofacial trauma [6,8,10,16–18].

These findings underscore the necessity of comprehensive preventive and clinical interventions, including mandatory full-face helmet regulations, age-specific trauma management strategies, strengthened road safety policies, and early screening for concomitant brain injuries based on facial fracture patterns as clinical indicators. By integrating quantitative analyses of trauma severity indices, detailed evaluations of helmet effectiveness, and insights into age-based and regional variations, this review offers a holistic understanding of mandibular fractures in motorcycle accidents, thus informing critical advances in both prevention and clinical trauma care.

CONCLUSION

This study highlights the substantial burden of mandibular fractures in motorcycle-related accidents, emphasizing the relationships of helmet use, trauma severity index scores, and demographic variations with injury patterns. Full-face helmets conferred superior protection, reducing the severity of condylar and symphyseal fractures, whereas half-face or absent helmets were associated with a significantly higher risk of severe fractures requiring surgical intervention. The demonstrated correlation between fracture location and intracranial injury further reinforces the importance of early screening and multidisciplinary management in trauma cases.

CLINICAL IMPLICATIONS

From a clinical perspective, these findings support the routine integration of trauma severity indices (such as the Abbreviated Injury Scale, Injury Severity Score, and Glasgow Coma Scale) into standard assessment protocols to inform prognosis and guide treatment decisions. Additionally, age-based and regional differences in mandibular fracture patterns suggest that targeted prevention strategies, including stricter helmet regulations and improved road safety measures, should be tailored based on risk demographics. This study also highlights the need for early identification of patients with concomitant head injuries, as specific fracture patterns may indicate a higher risk of intracranial trauma.

STUDY LIMITATIONS

Despite its contributions, this review has certain limitations. The sample size is relatively small, and the articles selected may have introduced bias. Furthermore, variations in study designs, patient populations, and trauma scoring methods among the included studies could limit the generalizability of the findings. Moreover, helmet effectiveness was assessed based on the available literature, but factors such as helmet fit, impact velocity, and compliance with safety standards were not uniformly evaluated across studies.

FUTURE RESEARCH DIRECTIONS

Future research should include prospective, large-scale cohort studies to establish causal relationships among helmet type, trauma severity, and long-term functional outcomes. Additionally, studies are needed to explore the role of environmental factors, such as road conditions, accident timing, and alcohol use, in the severity of mandibular fractures. Biomechanical assessments of the protective efficacy of different helmet designs could also be integrated to enhance preventive strategies. Finally, advancements in machine learning and artificial intelligence-based trauma assessment tools may help improve early diagnosis and treatment planning for patients with maxillofacial injuries. By addressing these gaps, future research can refine clinical guidelines, inform public health policies, and ultimately reduce the global burden of motorcycle-related mandibular fractures.

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