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Traumatic genial tubercle fracture: a case description with 9-month radiographic follow-up and a literature analysis.

Mandibular fractures are one of the most frequent fractures of facial bones (1). Diagnosis of these fractures can be determined by both clinical and radiological examination. Clinical findings may reveal alterations in occlusion, soft tissues laceration, alterations in lower lip and/or tongue sensation, and possible mouth floor elevation (2). Genial tubercles are sharp projections of bone on the lingual aspect of the mandible around the midline and at a mid-point between its inferior border and lower incisors apices (3,4). The morphological pattern of genial tubercles is very variable. Moreover, it is not influenced by the facial type or skeletal pattern (3). Five patterns (Figure 1) were described in the literature: the classical four spines (two inferior and two superior tubercles), two superior tubercles with one fused inferior tubercle, two superior tubercles with a rough impression bellow, one single median projection, or absence of any bony projections (5). They provide attachment for the genioglossus and geniohyoid muscles (5). Fracture of genial tubercle is an avulsion of the tubercle or a separation of the inner cortex along with the tubercle (2). According to the mechanism of injury, it can be classified into two types: denture-associated fracture in an atrophied mandible; and tubercle fracture in traumatically fractured mandible (2). The first type may occur due to repeated collisions of the removable denture edges on the tendinous attachment of the genioglossus muscle leading to multiple micro-fractures in the area of the tubercle (6). On the other hand, the genial tubercle fracture, which is associated with mandibular fracture, is rare with very few reported cases in the literature. This report aims to describe a case with this type of genial tubercle fracture and the offered conservative management. We also performed a literature search in PubMed, Scopus, and Google Scholar from inception until 10th of December 2020 with a combination of keywords (Trauma OR Symphysis OR Parasymphysis OR Parasymphyseal Fracture) AND (Genial Tubercle Fracture).