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

Abstract

Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic characteristics, surgical treatment, and clinical outcomes of surgical repair of mandible fractures in the United States. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult databases of the years 2006 through 2014 was performed identifying 940 patients with an International Classification of Diseases, version 9 (ICD-9) diagnosis of either closed or open fracture of the mandible. Preoperative, perioperative, and postoperative details were categorized and evaluated for these two cohorts. Multivariate analysis was performed to detect risk factors related to any complications. Patients were predominantly male (85.7%), young with a mean age of 34.0 ± 14.8 years, and relatively healthy with body mass index of 23.6 ± 8.2 and an American Society of Anesthesiologists (ASA) class of 1 or 2 (84.4%). However, more than half were regular smokers (51.1%). The top five most frequent procedures performed for mandibular repair were exclusively open surgical approaches with internal, external, or interdental fixation in both cohorts. Patients with open fractures were more often admitted as emergencies, treated inpatient, required longer operative times, and presented with more contaminated wounds ( < 0.05). Overall, medical (1.7%) and surgical complications (3.7%) were low. A high ASA class 3 or above and emergency operations were identified as risk factors for medical adverse events. Despite frequent concomitant injuries after trauma and a diverse array of mandibular injury types, our patient sample demonstrated favorable outcomes and low complication rates. Open surgical techniques were the most common procedures in this study representing the American population.

Patterns of Mandibular Fractures in South Australia: Epidemiology, Treatment, and Clinical Outcomes

“…An European multicenter study reported ORIF as the most common treatment, 24 in the present study, we similarly reported an operative rate of 75.6% and the remaining 24.4% were managed conservatively with serial reviews. Other studies generally reported similar operative rates, Gulateri's Italian study identified young males commonly presented with condylar fractures and had a total operative rate of 66.9% 25 .…”

ASA Physical Status Classification and Complications Following Facial Fracture Repair

“…[9][10][11] In addition, diabetes mellitus has been identified as a risk factor for complications following facial fracture repair in a study using the Nationwide Inpatient Sample database. 13 While ASA classification has been shown to be associated with rates medical complications after mandible fracture repair, 14 there has been to our knowledge, no prior study that explores the specific associations between ASA classification and complications following other facial fracture repairs. It has been well established that ASA class can help predict operative risk of morbidity and mortality.…”

Isolated favorable compound mandibular body fractures: A retrospective review of two cohorts of patients based on the timing of treatment

“…Increased times to treatment can encompass a number of different factors, including concomitant injuries taking precedence, admission to ICU, surgeon or operating room availability (particularly for complex and time-consuming cases), and transfer from a community hospital. 15,19,20 These factors did not influence the complication rates in the present study as most of them were controlled. From previous experience in the study environment, the time for surgical repair is also affected by financial constraints and ignorance of some patients on where to get the best care as the facility where this study was done is one of the few health institutions in Nigeria designated for the treatment of such cases.…”