The aetiology, presentation and management of fractured mandibles were investigated in a major accident and emergency department in 1983 and 1993. Demographic features of patients in both years were similar: most injuries were in males (89%), most were a result of an assault ( > 75%), and 50% of the patients presented for treatment between the hours of 10pm and 5am. There were striking reductions in the numbers of patients who waited more than 24-hours for an operation (60% in 1983; 34% in 1993), and out-of-hours operating (60% in 1983; 41% in 1993). There was an increase in the number of patients for whom consultants were the principal operator (13% in 1983; 32% in 1993). Changes in the methods of treatment included a decrease in the use of postoperative intermaxillary fixation (98% in 1983; 56% in 1993) and an increase in internal fixation using bone plates (2% in 1983; 53% in 1993). Total inpatient stay was the same in both study years (mean = 3 days), and there was no difference in duration of stay between treatment modalities (internal versus intermaxillary fixation).