Contemporary Management of Infected Mandibular Fractures

Abstract

The treatment of infected mandibular fractures has advanced rather dramatically over the past 50 years. Immobilization with maxillomandibular fixation and/or splints, removal of diseased teeth in the fracture line, external fixation, use of antibiotics, debridement, and rigid internal fixation has played a role in management. Perhaps the most important advance was the realization that infected fractures also result from moving fragments and nonvital bone, not just bacteria. Controlling movement and eliminating the dead bone allowed body defenses to also eliminate bacteria. The next logical step in the evolution of treatment was primary bone grafting of the resulting defect following application of rigid internal fixation and debridement of the dead bone. We offer our results with this treatment in 21 infected fractures, 20 of which achieved primary union.

Multi-institutional Analysis of Surgical Management and Outcomes of Mandibular Fracture Repair in Adults

“…In addition, these data suggest that the choice for an open procedure was not based on the patient's dental health alone. External fixation, which was used in 2.9% of cases, is reserved for the most complicated fractures with large soft-tissue defects or when immediate jaw bone repair is not possible 13. These surgical details and the distribution of procedures in this study indicate that our patient sample was in fact suffering from more complex fracture patterns, given that conservative treatment was so infrequently applied (Table 2).…”

Retrospective Study on Multidrug-Resistant Bacterium Infections After Rigid Internal Fixation of Mandibular Fracture

“…12,13 Some studies have shown that the amount of internal fixation materials and fixation stability are closely related to increased infection risk. 14 Increased amount of fixation materials 15,16 and decreased stability 14 will increase the risk of infection. In recent years, use of the reconstruction plate has drawn much attention.…”

“…Previous studies have shown that the prognosis of comminuted fracture treatment is related to the degree of commutation, use of internal fixation materials, and the movement of fractured bones in relation to infection. 14 Thus, unstable small fragments should be removed and larger fractures should be fixed as often as possible using a full loadbearing system. 17,18 Especially for patients with reinfection, it is best to use a reconstruction plate or a locking plate for fixation.…”

Secondary Management of Mandible Fractures

“…There has been a paradigm shift in the past couple decades regarding the best secondary management of mandibles with nonunion and infection. 6 Traditionally, a two-stage approach of repair was advocated; the first stage involved controlling the infectious process with removal of involved teeth, drainage of any abscess, and the administration of antibiotics. After demonstration of resolution of the infection, then a secondary surgery could be undertaken with reduction and fixation of the bony segments.…”