Management of Mandible Fractures by the Oral Maxillofacial Surgery Department at University of Maryland: A Quality Assessment Initiative

Abstract

Purpose Repair of isolated mandibular trauma has been well documented in the literature. Outcomes based on methods of fixation, tooth extraction in the line of fracture, and treatment complications have been well documented. At the University of Maryland Oral and Maxillofacial Surgery (OMFS) unit, isolated mandibular factures are treated immediately, and rigid fixation is preferred. We performed a quality assessment of our treatment protocol for treated isolated mandible fractures, focusing on postoperative complications, such as surgical site infections (SSIs), nonunion, and malocclusion. Methods A retrospective chart review of patients who received intervention for mandibular fractures was conducted from December 2013 to July 2017 at the University of Maryland OMFS unit. All included patients were treated in an operating room (OR) setting. Demographics (age, gender, and race), mechanism of injury, location of fracture(s), type of fixation/number of plates used, tooth in line of fracture, length of maxillomandibular fixation, and time to OR were recorded. Complications, such as SSIs, wound dehiscence, dental mobility/sensitivity, malocclusion, and nonunion, were recorded. Primary outcome measured was mandibular union. Results One hundred and sixty-eight patients with a total of 301 fractures were identified. 80% were males, and 61.3% were African Americans. Homelessness, substance abuse, and incarceration were highly prevalent in our patient population. Assault was the most common cause of mandibular trauma (58%). Individuals in their third (35%) and fourth (22%) decades of life were most commonly affected. Symphysis and parasymphysis (32%) were the most commonly affected sites, followed by mandibular angle (29%). Sixty-six percent of individuals had 2 or more fractures. Seventy-seven percent of patients underwent definitive repair within 48 hours of presentation. Overall rate of postoperative complications was 10%; SSI (4%) was the most common, followed by wound dehiscence (2%), dental pain or dental mobility at the line of fracture (1.6%), malocclusion (1%), and nonunion (1%). Conclusions In our study, the primary goal of union was achieved in 98.6% patients. Four patients with nonunion were treated secondarily, with good results. An overall complication rate of 10% was noted with an SSI rate of 4%. These are both lower than those reported in literature. In conclusion, it is essential to tailor treatment in accordance with the challenges posed by the individual patient.