A Comparison of Outcomes Between Immediate and Delayed Repair of Mandibular Fractures

Abstract

Medical records of patients treated with surgical repair of mandible fractures by the otolaryngology and plastic surgery departments at a level 1 trauma centre were obtained and reviewed. Two study groups were compared: patients treated within 72 h of the injury and those treated after this time period. Patient demographics, time to repair, fracture types, substance abuse history, etiology, surgical management, complications and length of hospital stay were assessed. The complication rate was 41% (n=7) within the immediate group and 38% (n=6) within the delayed group (P=0.56). Complications were prevalent in patients with history of substance abuse in both groups. Complication rates did not increase when repair of mandible fractures was delayed beyond 72 h, while substance abuse was a factor in increasing complications rates. Outpatient triage with elective repair of isolated mandibular fractures appears to be more cost-effective than admission with inpatient management.

Inflammatory Morbidity due to Compound Mandibular Body Fractures: Does It Have a Relationship with Treatment Outcome?

“…Conversely, Biller et al [ 1 ] reported that complications increased with treatment delay. The present study differed from these previous reports [ 1 , 6 ] as substance abuse was cited in both as a risk factor in the development of complications, and the method of treatment was by rigid internal fixation, while the role of posttraumatic pain and trismus were not assessed. However, Hermund et al [ 5 ] and Hurrell and Batstone [ 13 ] reviewed the literature and stated that with the current research evidence based on treatment outcome a definitive conclusion cannot be drawn on the optimal timing of the treatment of mandibular and other facial fractures.…”

“…These variables were the direct and immediate consequence of the inflammatory response associated with the traumatic injuries that led to the fractures [ 3 , 4 ]. Webb et al [ 6 ] observed that complication rates were lower when repair of mandibular fractures was delayed beyond 72 h, and suggested that a delay in treatment was more cost-effective than early (immediate) treatment. Conversely, Biller et al [ 1 ] reported that complications increased with treatment delay.…”

“…This explains the variability in the degree of response to pain and trismus among the patients documented in the present study. However, the orofacial morbidities resulting from the edema, such as pain, trismus and swelling, are serious issues as they affect the ability of the patients to interact with others and return to their routine social and working life [ 5 , 6 ]. Also, fractures of the mandible can be complex, challenging and sometimes may have a significant impact on a patient's quality of life [ 1 , 2 , 3 , 4 ].…”

“…However, complications from mandibular fractures often develop before, during or after treatment [ 3 , 5 ]. Many studies have shown that these complications are attributable to many factors, such as the age of the patient, the type and site of the fracture, the medical status of the patient, substance abuse, teeth in the line of the fracture, the type and cost of treatment, inadequate reduction or stabilization, the competence of the surgeon, and poor patient compliance to instructions after treatment [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. There appears to be no consensus in the literature on the most prevalent factors associated with complications following mandibular fracture.…”

Evaluation of Rhombic Three Dimensional Plate in Fixation of Displaced Low Subcondylar Mandibular Fractures

“…Recent studies have shown no increase in complications with a delay of repair beyond 24 hours until 7 days. 23,24 In our sample, stabilization was performed with 3D rhombic condylar fracture plate .This type of osteosynthesis showed none of the plates fractured, none bent or loosened screws during all recall periods, this is due to its rhombus shape which provides internal stability, as well as more optimal leverage that counteract posterior or anterior loads onto the proximal fragment.…”