Factors contributing to the surgical retreatment of mandibular fractures

João Gualberto De Cerqueira Luz,Rogerio Bonfante Moraes,Marcos Kazuo Yamamoto,Ricardo Pimenta D'Ávila

doi:10.1590/s1806-83242013005000007

João Gualberto De Cerqueira Luz, Rogerio Bonfante Moraes + Show 2 more

Open Access

https://doi.org/10.1590/s1806-83242013005000007

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Abstract

The purpose of this retrospective study was to evaluate contributing factors in patients requiring surgical retreatment of mandibular fractures. Of all the patients with mandibular fractures who were treated using internal fixation at a trauma hospital over a seven-year period, 20 patients (4.7%) required a second surgery and thus composed the "reoperated" group. The control group comprised 42 consecutive patients with mandibular fractures who were treated at the same clinic and who healed without complications. Medical charts were reviewed for gender, age, substance abuse history, dental condition, etiology, location of fracture, degree of fragmentation, fracture exposure, teeth in the fracture line, associated facial fractures, polytrauma, time elapsed between trauma and initial treatment, surgical approach and fixation system. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0; descriptive statistics and the chi-squared test were used to determine differences between groups. Significant differences in substance abuse (p = 0.006), dental condition (p < 0.001), location of fracture (p = 0.010), degree of fragmentation (p = 0.003) and fracture exposure (p < 0.001) were found. With regard to age and time elapsed between trauma and initial treatment, older patients (31.4 years, SD = 11.1) and a delay in fracture repair (19.1 days, SD = 18.7) were more likely to be associated with reoperation. It was concluded that substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and the time between trauma and initial treatment should be considered contributing factors to the occurrence of complications that require surgical retreatment of mandibular fractures.

Highlights

The ideal method for treating mandibular fractures is rigid or stable internal fixation using plates or miniplates.[1,2] Rigid or stable fixation, or internal fixation, is a more cost-effective treatment than non-rigid methods, in part due to the decreased probability of postoperative complications,[2] that could necessitate further surgery
This study evaluated factors in patients that may contribute to the surgical retreatment of mandibular fractures that were initially treated using internal fixation compared with mandibular fractures without complications and found significant differences between groups in patient characteristics, fracture characteristics and surgical treatment
With regard to the surgical treatment, a significant difference was found between groups in the time elapsed between the trauma and the initial treatment; the elapsed period was longer in the reoperated group

Summary

Introduction

The ideal method for treating mandibular fractures is rigid or stable internal fixation using plates or miniplates.[1,2] Rigid or stable fixation, or internal fixation, is a more cost-effective treatment than non-rigid methods, in part due to the decreased probability of postoperative complications,[2] that could necessitate further surgery. Infection is a common initial complication following the surgical treatment of mandibular fractures, which, in more severe cases, may progress to osteomyelitis and pseudoarthrosis.[4,5] Other complications requiring reoperation include the nonunion or abnormal union of bone tissue and soft tissue infection associated with screw loosening or plate exposure Such complications may require further fixation, exploratory surgery to remove the fixation materials, the removal of bone sequestration and refracture.[4,6,7,8]

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