Risk Factors Associated With Complications After Treatment of Mandible Fractures

Abstract

IMPORTANCEComplications that arise after treatment of mandible fractures can result in significant morbidity. Identifying modifiable risk factors associated with these complications is valuable in guiding clinical practice for improved patient outcomes.OBJECTIVE To describe the risk factors associated with complications in patients undergoing treatment for mandible fracture. DESIGN, SETTING, AND PARTICIPANTSA retrospective review was conducted of 137 patients presenting to a tertiary care, level 1 trauma center with mandible fractures between January 1, 2014, and January 1, 2017. Outcomes and demographic characteristics for patients with at least 3 weeks of follow-up were compared using multivariate logistic regression analysis. RESULTSOf the 137 patients meeting inclusion criteria, there were 113 males (82.5%) and 24 females (17.5%), with a mean (SD) age at presentation of 32.3 (15.7) years. Median follow-up was 71 days (range, 22-1189 days). Postoperative complications were identified in 29 patients (21.2%); complications included wound dehiscence or surgical site infection (n = 17), bony nonunion (n = 5), and hardware exposure (n = 13). Complications were managed surgically in 19 patients and nonsurgically in 10 patients. On univariate analysis, the initial surgery was completed later (mean [SD], 5.9 [6.6] days after injury) in patients who developed complications than in those who did not (mean [SD], 3.8 [4.0] days). On multivariate analysis, complications were associated with increased time from injury to treatment (odds ratio [OR], 1.60; 95% CI, 1.02-2.53; P = .04), tobacco use (OR, 8.10; 95% CI, 1.26-52.00; P = .03), and dental extraction (OR, 93.00; 95% CI, 1.19 to >999.00; P = .04). Residence in the same city as the medical center was associated with fewer complications (OR, 0.08; 95% CI, 0.01-0.69; P = .02). CONCLUSIONS AND RELEVANCEIn a 3-year review of mandible fractures managed at a single academic center, complications were associated with an increased time to treatment, tobacco use, dental extraction, and living farther from the treatment facility. On a systems level, the results of this study suggest that expediting intervention for mandible fractures may improve outcomes.LEVEL OF EVIDENCE 3.

Skeletal Stem Cell-Schwann Cell Circuitry in Mandibular Repair

“…Although interaction between nervous and bony tissue during skeletal development and repair has been shown in several models (Aro, 1985; Dysart et al, 1989; Johnston et al, 2016; Recidoro et al, 2014; Rinkevich et al, 2011), our study directly links Schwann cells with mSSCs enacting mandibular bone repair. Clinically, mandibular fractures persist as a significantly challenging problem associated with high nerve injury and healing complication rates (Hsieh et al, 2019; Tay et al, 2015). Harnessing the underlying biology of nerve-dependent mandibular repair may hold promise for clinical innovation in mandible skeletal tissue repair, and we establish the importance mSSC and Schwann cell circuitry to facilitate mandibular healing.…”

Stability as a Key Factor for Bone Repair in Nonunion of Mandibular Osteotomy

“…These results show that the stability and proximity of the bone fragments play great importance in proper bone repair. Factors like a long waiting time before stabilization of the fracture, use of tobacco and tooth extractions have been cited as risk factors for complications in fracture healing, including nonunion (Hsieh et al, 2019). For these reasons, the quality and quantity of the fixation material are critical through their ability to support the immobilization of the segments and provide sufficient mechanical stability for the patient and the type of fracture beingtreated (Rodriguez Chessa et al, 2014;de Medeiros et al, 2016;Meram et al, 2018).…”

A Cross-Sectional Study to Assess the Risk Factors for Hypoesthesia After Repair of Facial Fractures

“…The surgical procedure for the repair of facial fractures giving rise to multivariate clinical complications such ashardware exposure or extrusion, surgical site infection, wound dehiscence, bony nonunion or malunion, along with a range of other clinical complications. 3 Some of the complications associated with surgical procedures carried out for the management of facial bone fractures also include asymmetry, infection, disturbed healing of wound, malocclusion, and malar depression. 4 However, hypoesthesiais regarded one of the most common complexities occurring after the after repair of facial fractures.…”