CRANIOMAXILLOFACIAL TRAUMA
Outcomes of Mandible Fracture Treatment at an Academic Tertiary Hospital: A 5-Year Analysis Rajesh Gutta, BDS, MS,* Kyle Tracy, DMD,y Christopher Johnson, DDS,z Laura E. James, MS,x Deepak G. Krishnan, BDS,k and Robert D. Marciani, DMD{ Purpose:
To analyze the outcomes of mandible fractures treated using open reduction and internal
fixation. Patients and Methods:
We performed a retrospective chart review of the medical records from patients with mandibular fractures treated surgically during a 5-year period for demographics, systemic illness, history of substance abuse, etiology, fracture location, any associated facial injury, type and timing of repair, antibiotic treatment, and interval to repair. The development of complications such as infection, malunion or nonunion, hardware failure, and wound dehiscence were recorded.
Results:
Of the 560 patients, adequate data were collected for 363 patients. Of the patients, 60% were white. The male/female ratio was 7.4:1. Systemic illness was noted in 10.5% of the cohort. More than 80% of the subjects had sustained their injury because of assault. The mandible angle was the most common site of fracture (56%). Most (64%) of the patients had sustained multiple fractures. When multiple sites were involved, the angle and body were more commonly involved. The overall complication rate was 26.45%. Hardware failure (15.4%) was the most common complication, followed by infection (15.15%). The revision rate was 8.1% in this cohort. Antibiotic usage and the infection rate were not statistically associated with each other. A greater complication rate was noted among smokers (P = .0072) and patients with systemic illness (P = .0495).
Conclusions: A greater rate of hardware failure was noted in our study. The use of antibiotics did not decrease the incidence of infections. Smokers and patients with systemic medical conditions had a greater risk of complications. Finally, a slight delay in surgical repair was not related to an increased complication rate. Ó 2014 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 72:550-558, 2014
internal fixation using various profile plates, closed treatment with external fixation, and treatment with Kirschner wires.1 Despite advances, treatment of mandibular fractures has continued to be associated with multiple complications. Mandibular angle fractures, in particular, have been fraught with high postoperative complication rates.2,3 Several factors can contribute to
Fractures of the mandible are treated to restore the function, anatomy, and form. Depending on the location and surgical skills, various treatment strategies have been described and used in the management of these fractures. These have included nonoperative management, treatment with intermaxillary fixation (IMF), open treatment with reduction, open treatment with
{Professor and Chief, Division of Oral and Maxillofacial Surgery,
*Voluntary Assistant Professor, Division of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH; and Private
University of Cincinnati, Cincinnati, OH.
Practice, Mountain State Oral and Maxillofacial Surgeons, Charleston,
Conflict of Interest Disclosures: None of the authors reported any
WV.
disclosures.
yResident, Division of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH.
Address correspondence and reprint requests to Dr Gutta: Mountain State Oral and Maxillofacial Surgeons, 1215 Virginia Street East,
zResident, Division of Oral and Maxillofacial Surgery, University
Charleston, WV 25301; e-mail: [email protected]
of Cincinnati, Cincinnati, OH.
Received March 17 2013
xResearch Associate, Department of Surgery, University of
Accepted September 4 2013 Ó 2014 American Association of Oral and Maxillofacial Surgeons
Cincinnati, Cincinnati, OH. kAssistant Professor and Program Director, Division of Oral and
0278-2391/13/01192-0$36.00/0
Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH.
http://dx.doi.org/10.1016/j.joms.2013.09.005
550
551
GUTTA ET AL
the high incidence of complications, including a lack of an appropriate protocol, inappropriate technique, the patient’s medical condition, fracture type, substance abuse, number of fractures, concomitant injuries, unique function, timing of fracture repair, and fracture location. The complications can included infection, osteomyelitis, nonunion, malunion, and wound dehiscence.4-6 The present study attempted to evaluate the outcomes of open treatment of mandible fractures at an academic healthcare facility using a 5-year retrospective chart review.
Patients and Methods This was a retrospective study of patients treated for mandible fractures by the oral and maxillofacial surgery division during in a 5-year period at an academic level I trauma center. Only mandible fractures treated with open reduction and internal fixation were included in the present study. Comminuted or infected fractures were also included. Pediatric (age
Outcomes of Mandible Fracture Treatment at an Academic Tertiary Hospital: A 5-Year Analysis Rajesh Gutta, BDS, MS,* Kyle Tracy, DMD,y Christopher Johnson, DDS,z Laura E. James, MS,x Deepak G. Krishnan, BDS,k and Robert D. Marciani, DMD{ Purpose:
To analyze the outcomes of mandible fractures treated using open reduction and internal
fixation. Patients and Methods:
We performed a retrospective chart review of the medical records from patients with mandibular fractures treated surgically during a 5-year period for demographics, systemic illness, history of substance abuse, etiology, fracture location, any associated facial injury, type and timing of repair, antibiotic treatment, and interval to repair. The development of complications such as infection, malunion or nonunion, hardware failure, and wound dehiscence were recorded.
Results:
Of the 560 patients, adequate data were collected for 363 patients. Of the patients, 60% were white. The male/female ratio was 7.4:1. Systemic illness was noted in 10.5% of the cohort. More than 80% of the subjects had sustained their injury because of assault. The mandible angle was the most common site of fracture (56%). Most (64%) of the patients had sustained multiple fractures. When multiple sites were involved, the angle and body were more commonly involved. The overall complication rate was 26.45%. Hardware failure (15.4%) was the most common complication, followed by infection (15.15%). The revision rate was 8.1% in this cohort. Antibiotic usage and the infection rate were not statistically associated with each other. A greater complication rate was noted among smokers (P = .0072) and patients with systemic illness (P = .0495).
Conclusions: A greater rate of hardware failure was noted in our study. The use of antibiotics did not decrease the incidence of infections. Smokers and patients with systemic medical conditions had a greater risk of complications. Finally, a slight delay in surgical repair was not related to an increased complication rate. Ó 2014 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 72:550-558, 2014
internal fixation using various profile plates, closed treatment with external fixation, and treatment with Kirschner wires.1 Despite advances, treatment of mandibular fractures has continued to be associated with multiple complications. Mandibular angle fractures, in particular, have been fraught with high postoperative complication rates.2,3 Several factors can contribute to
Fractures of the mandible are treated to restore the function, anatomy, and form. Depending on the location and surgical skills, various treatment strategies have been described and used in the management of these fractures. These have included nonoperative management, treatment with intermaxillary fixation (IMF), open treatment with reduction, open treatment with
{Professor and Chief, Division of Oral and Maxillofacial Surgery,
*Voluntary Assistant Professor, Division of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH; and Private
University of Cincinnati, Cincinnati, OH.
Practice, Mountain State Oral and Maxillofacial Surgeons, Charleston,
Conflict of Interest Disclosures: None of the authors reported any
WV.
disclosures.
yResident, Division of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH.
Address correspondence and reprint requests to Dr Gutta: Mountain State Oral and Maxillofacial Surgeons, 1215 Virginia Street East,
zResident, Division of Oral and Maxillofacial Surgery, University
Charleston, WV 25301; e-mail: [email protected]
of Cincinnati, Cincinnati, OH.
Received March 17 2013
xResearch Associate, Department of Surgery, University of
Accepted September 4 2013 Ó 2014 American Association of Oral and Maxillofacial Surgeons
Cincinnati, Cincinnati, OH. kAssistant Professor and Program Director, Division of Oral and
0278-2391/13/01192-0$36.00/0
Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH.
http://dx.doi.org/10.1016/j.joms.2013.09.005
550
551
GUTTA ET AL
the high incidence of complications, including a lack of an appropriate protocol, inappropriate technique, the patient’s medical condition, fracture type, substance abuse, number of fractures, concomitant injuries, unique function, timing of fracture repair, and fracture location. The complications can included infection, osteomyelitis, nonunion, malunion, and wound dehiscence.4-6 The present study attempted to evaluate the outcomes of open treatment of mandible fractures at an academic healthcare facility using a 5-year retrospective chart review.
Patients and Methods This was a retrospective study of patients treated for mandible fractures by the oral and maxillofacial surgery division during in a 5-year period at an academic level I trauma center. Only mandible fractures treated with open reduction and internal fixation were included in the present study. Comminuted or infected fractures were also included. Pediatric (age
