Fractures involving the maxillofacial skeleton are quite common, with a high rate of incidence in developing countries (Telfer et al., 1991; Sakr et al., 2006; Agarwal and Mehrotra, 2020). The most common etiological factors are road traffic accidents (RTAs), assaults, accidental falls, sports injuries, and gunshot injuries (Adi et al., 1990; Sever et al., 2011). According to WHO, RTAs account for more than 50 million injury cases every year, with over 1.2 million people losing their lives. In India — a densely populated country — trauma claims hundreds of thousands of lives every year. Among the maxillofacial fractures, mandibular fractures are the second most common, with an incidence of 25–75% (Kambalimath and Sridhar, 2019).

The mandible is the largest, strongest, and only movable facial bone, and constitutes the lower third of the facial skeleton (Mitsukawa et al., 2004; Jain et al., 2020). It is often subjected to fracture because of its prominent position and mechanically weaker sections, which include the angle, condylar process, and bilateral mental region (Watts, 1988; Jadhav et al., 2015). Most often, these fractures occur either due to direct or contrecoup injuries. Factors determining the site of fracture include the area of force applied, and the direction, severity, and velocity of the force (Natu et al., 2012; Jajodia et al., 2017). Fractures involving multiple anatomical sites in different planes, which cannot be categorized into existing anatomical classifications, are termed as unusual fractures.

In the literature, these fractures are often classified according to their anatomical location, i.e. symphysis, parasymphysis, body, angle, ramus, coronoid, or condyle (Passi et al., 2017). Other fracture variables include involvement of dentition, and displacement and favorability of fractured segments (Passi et al., 2017). In recent times, there have been remarkable changes in fracture patterns owing to varying etiology and new types of injury. Moreover, increasing urbanization has led to a rapid influx of high-speed automobiles in conjunction with poor road conditions (Menon et al., 2019). There is a lack of research in the literature regarding fractures passing through the different anatomical regions of the mandible.

The purpose of this retrospective study was to devise and summarize a classification of mandibular fracture patterns involving multiple anatomical sites.