title: Undiagnosed mandibular condylar fractures causing temporomandibular joint ankylosis: A problem in northern India.
abstract: BACKGROUND
  Temporomandibular joint (TMJ) ankylosis due to undiagnosed condylar fractures has a high incidence in India compared to western countries. We evaluated the demographics, injury pattern, hospital reporting and referral pattern of undiagnosed condylar fractures complicating TMJ ankylosis in northern India.
  
  
  METHODS
  We did a retrospective analysis by retrieving medical records of patients with post-traumatic TMJ ankylosis reporting to the Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences between 1 July 2012 and 30 June 2013.
  
  
  RESULTS
  Of 90 patients with post-traumatic TMJ ankylosis, 74 (82.2%) resided in rural areas. Sixty-three (70%) patients were from the states of Uttar Pradesh, Bihar and Jharkhand. Only 8.8% had higher education and 10% had an annual income of more than `2 lakh. In 69 (84.4%) patients, fall was the aetiological factor. Primary health centres (42%) and private clinics (20.5%) received the major share of patients immediately following injury. Few patients (19.3%) had some radiographic examination done and only 17% were referred by the primary healthcare provider. Of those referred only 3 were examined by a dental practitioner. Only 10% of all were diagnosed with condylar fractures.
  
  
  CONCLUSIONS
  Patients with TMJ ankylosis presenting to us have poor literacy and income levels. A missed diagnosis of condylar fractures by rural healthcare providers contributes to its high incidence in India. Improving awareness of clinicians and improved rural healthcare infrastructure can help prevent this complication.
authors.affiliation: PCentre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Shakil Ahmed
authors.initials: SA
authors.lastname: Nagori
authors.affiliation: PCentre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Anson
authors.initials: A
authors.lastname: Jose
authors.affiliation: PCentre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Ongkila
authors.initials: O
authors.lastname: Bhutia
authors.affiliation: PCentre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Ajoy
authors.initials: A
authors.lastname: Roychoudhury
mesh_terms: D000293:Adolescent; D000844:Ankylosis / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007194:India; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries*; D008337:Mandibular Fractures / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013705:Temporomandibular Joint Disorders / Q000453:epidemiology* / Q000209:etiology