Mandibular Fracture Repair Research Articles

Risk Factors for Postoperative Complications Following Mandibular Fracture Repair.

Complications following mandibular fracture repair (MFR) may carry significant morbidity to patients. The purpose of our study is to determine the risk factors for postoperative complications following MFR. The authors conducted a retrospective cohort study of trauma patients who underwent MFR in 2018 and 2019. Excluded were patients below 18 years old and those with postoperative follow-up <2 weeks. The primary outcome was the incidence of major and minor postoperative complications following MFR. Of n=275 patients included, mean (SD) age was 35 (14) years and median (IQR) follow up was 49 (26-117) days. Most patients [n=208 (76%)] underwent both maxillomandibular/intermaxillary fixation (MMF/IMF) and open reduction and internal fixation (ORIF). The incidence of major postoperative complications was 19% (n=51) including malunion [n=8 (2.9%)], malocclusion [n=21 (7.6%)], and unplanned reoperation [n=26 (9.5%)]. The incidence of minor postoperative complications was 61% (n=167). Alcohol use at the time of surgery and greater MISS score were associated with greater odds of major complications [adjusted odds ratio (aOR) 95% CI: 3.4 (1.2-9.0), 1.09 (1.02-1.160), respectively]. Smoking at the time of surgery and moderately (>2mm) and severely displaced fractures (>4mm) were associated with greater odds of minor complications [aOR (95% CI): 2.1 (1.04-4.2), 2.7 (1.2-6.4), 2.7 (1.1-6.6), respectively]. Alcohol use, smoking, greater MISS score, and displaced fractures >2mm were significant risk factors for postoperative complications following MFR. Our findings can help guide informed decision making and surgical planning in patients with mandibular fractures.

Do Postoperative Surgeon Phone Calls Improve Outcomes Following Mandibular Fracture Repair?

Complications of open reduction and internal fixation (ORIF) of mandibular fractures are influenced by several patient factors. A postoperative surgeon phone call could modify these factors through education and reinforcement of instructions, but its effect has not been studied. The purpose of this study was to measure and compare the frequencies of postoperative inflammatory complications (POICs) following ORIF of mandibular fractures in patients who did and did not receive a postoperative surgeon phone call. The authors conducted an ambispective cohort study consisting of patients with mandibular fractures treated with ORIF at a large urban trauma hospital with the prospective cohort from January 1, 2021 to March 31, 2022 and a retrospective cohort from April 1, 2020 to December 31, 2020. Prisoners and patients with gunshot wounds were excluded. The primary predictor variable was the surgeon call group. After January 2021, a postoperative call was implemented 1-3days following fracture repair to review instructions, such as nonchew diet and oral hygiene, and provide education, such as reviewing expectations. Prior to January 2021, patients were not called. This resulted in 3 categories: Not Called, Called and Answered, and No Answer. The primary outcome variable was POICs, defined as the occurrence of exposed or infected hardware, abscess formation, recurrent swelling/pain, nonunion, osteomyelitis, or fistula formation. Demographic variables, injury-related variables, and treatment-related variables were also measured. Statistical analysis was performed using Fisher's exact and Wilcoxon rank-sum tests, as well as multivariable logistic regression. A P value was considered significant if<.05. Of the 178 patients in the study, 137 (77%) were male and the average age was 39.9±12.6years. Sixty-five patients (36.5%) were not called. Of the patients called, 79 (44.4%) answered and 34 (19.1%) did not answer. POICs occurred in 9.2% of the Not Called group and 8.9% of the Called and Answered group (P=.99). In the No Answer group, 29.4% had POICs, which was higher than the other 2 groups (P=.01). A surgeon phone call was not associated with complication rates; however, patients in the No Answer group were significantly more likely to experience a POIC.

The Effects of Supplemental Vitamin C in Mandibular Fracture Patients: A Randomized Clinical Trial

Vitamin C is an oxidative stress mediator and essential cofactor in wound healing. The objective of this study was to investigate the clinical and biochemical effects of vitamin C supplementation on outcomes in patients undergoing mandibular fracture repair. We also aimed to evaluate the effects of sociodemographic, fracture, and treatment characteristics on post-operative clinical outcomes in these patients. The investigators conducted a double-blind, placebo-controlled, randomized clinical trial at Two Metropolitan, Level 1 Trauma Centers to prospectively evaluate the effects of vitamin C vs. placebo in a mandibular fracture population stratified by smoking and fracture status (open vs. closed). The study was conducted at two safety-net hospitals, enrolling a cohort of heavily underserved patients. Forty-five subjects were evaluated. We found decreased overall post-operative complications, decreased wound infection, and some improved bone healing outcomes in the vitamin C group compared to placebo, however, none of these outcomes reached statistical significance. Vitamin C intervention showed a signal of improved clinical and biological wound healing which was not statistically significant. Additionally, significant associations between patient characteristics and post-operative outcomes were identified. Older subjects and those with co-existent trauma were more likely to have increased healthcare utilization, and increased time from injury to surgery was significantly associated with frank infection. Prescription of additional opioids outside of standard practice was significantly associated with a need for additional wound care, increased emergency room visits, and any post-operative complication. Further investigation is needed to evaluate these findings in a larger study population, yet Vitamin C remains a low-risk, inexpensive potential means to improve wound healing outcomes after acute facial trauma.

Does a Postoperative Physician Phone Call Decrease Complications, Improve Patient Satisfaction or Reduce Emergency Department Visits Following Mandibular Fracture Repair?

Does a Postoperative Physician Phone Call Decrease Complications, Improve Patient Satisfaction or Reduce Emergency Department Visits Following Mandibular Fracture Repair?

Operative Facial Fracture Patterns in Cannabis Users: A Propensity Score-Matched Analysis

Introduction: Cannabis is the third most used recreational substance in the United States. Each year, more and more states pass legislation to legalize it for both medical and recreation use. As the prevalence of cannabis use increases, it is important to study the implications for patient care, not simply the potential interactions with wound healing, and perioperative analgesia. Facial fractures are among the most common traumatic presentations for the plastic surgeon. As such, the present study aims to characterize the operative facial fracture patterns in cannabis users. Methods: The IBM MarketScan Research Databases were queried from the years 2017 to 2021. Cohorts were identified in the inpatient dataset using International Classification for Disease, 10th Revision Procedure Coding System (ICD-10-PCS) codes for facial fracture repair procedures. The cannabis cohort was separated based on presence of ICD-10 codes pertaining to cannabis use diagnoses. The cohorts were propensity-score matched using an approximate 4:1 matching ratio. Baseline cohort demographics were reported and compared including age, gender, geographic region, employment status, insurance plan type, and fracture repair type. Multivariate regression analysis was used to determine the relationship between cannabis use and fracture repair patterns. Results: There were 104 patients in the cannabis cohort and 480 in the control cohort after propensity score matching. The cannabis group had a higher proportion of male patients (80.8%vs 69.0%, P = .016) and a lower proportion of the age range from 18 to 34 years (4.8%vs 15.8%, P = .035). Employment types were different between the 2 cohorts, with more patients in the control cohort working full time (82.3%vs 69.2%, P = .045). Cannabis users had significantly less maxillary fracture repairs (1.9%vs 19.4%, P &lt; .001). Cannabis users also had significantly more frontal fracture repairs (1.9%vs 0.2%, P = .027) and mandibular fracture repairs (76.9%vs 63.8%, P = .010). Multivariate regression revealed that cannabis users have 1.8 times greater odds of undergoing mandibular fracture repair ( P = .020) and significantly lower odds of undergoing maxillary (OR 0.07, P = .001). Conclusion: There are significant differences in the fracture patterns for cannabis users undergoing operative management and those who do not use cannabis. While mandibular fractures were the most common fracture repair type overall, cannabis users had significantly higher odds of undergoing mandibular fracture repair. This may indicate that cannabis users are more likely to sustain injuries that require operative intervention. Further study is needed to identify the relative incidences of facial fractures among cannabis users and its implications on operative considerations.

Analysis of postoperative complications related to cannabis and tobacco usage in patients undergoing mandible facial fracture surgeries

Cannabis is the third most used controlled substance in the world. Despite its widespread use, minimal research investigates cannabis usage in patients undergoing facial fracture surgeries. This study aimed to evaluate patterns of postoperative complications related to cannabis and tobacco usage after mandible fracture surgeries. PearlDiver™, a commercially available healthcare database, was used to identify patients endorsing the use of cannabis, tobacco, or both who underwent mandible fracture surgeries for cross-sectional analysis. The study population was categorized into groups using the Classification of Diseases, 9th revision (ICD-9), ICD-10, and Current Procedural Terminology (CPT) codes. A chi-square analysis was performed to assess the influence of cannabis and tobacco use on postoperative complications. A total of 8288 patients met the inclusion criteria, with 72 patients with cannabis-only usage, 914 patients with cannabis and tobacco usage, 3236 patients with tobacco-only usage, and 4066 in the control group. For patients using only cannabis, there was not an increased risk of developing postoperative complications compared with the control population. Patients with concurrent cannabis and tobacco usage and those with tobacco-only usage had an increased risk of surgical site infection, facial nonunion, facial abscess, debridement, and malocclusion after surgical repair of mandibular facial fracture. Patients with tobacco-only as well as cannabis and tobacco usage had an increased risk of all postoperative complications, except malocclusion, compared with cannabis-only. Based on the results of this study, it is recommended that healthcare providers consider a patient's history of tobacco use when planning and performing surgical treatment for traumatic mandible fractures.

Trends in Maxillomandibular Fixation Technique at a Single Academic Institution.

Retrospective chart review. Restoration of premorbid occlusion is a key goal in the treatment of mandibular fractures. Placement of the patient in maxillomandibular fixation (MMF) is performed during mandibular fracture repair to help establish occlusion. A number of techniques are available to achieve MMF. We sought to examine trends in MMF technique at our institution. A retrospective chart review was conducted to evaluate patients who underwent surgical treatment of mandibular fractures between January 1, 2011 and March 31, 2021. Data including fracture characteristics, mechanism of injury, patient demographics, complication rates, and MMF technique utilized were collected. One hundred sixty-three patients underwent MMF (132 males). The most common etiology of fracture was assault (34%). There was an increasing preference for rapid MMF techniques over time, as opposed to standard Erich arch bars. No significant difference in obtaining adequate fracture reduction as determined by postoperative imaging or complications were noted between those who underwent MMF with newer rapid techniques vs traditional MMF techniques. Our institution has demonstrated changing trends in the technique utilized for establishing occlusion intraoperatively, more recently favoring rapid MMF techniques, with similar rates of complications and ability to adequately reduce fractures.

Evaluation of Titanium Mini Plates for Repair of Mandibular Fractures in Clinical Cases of Dogs

Evaluation of Titanium Mini Plates for Repair of Mandibular Fractures in Clinical Cases of Dogs

Preoperative Prophylactic Antibiotics in Mandibular Fractures and Surgical Site Infection.

Compared with other facial fractures, mandibular fractures have the highest rate of postsurgical site infection. There is strong evidence to suggest that postoperative antibiotics do not reduce rates of surgical site infections (SSIs) regardless of duration. However, there are conflicting data in the literature regarding the role of prophylactic preoperative antibiotics in reducing rates of SSIs. This study reviews the rate of infections in patients who underwent mandibular fracture repair who received a course of preoperative prophylactic antibiotics compared with those who received no or 1 dose of perioperative antibiotics. Adult patients who underwent mandibular fracture repair at Prisma Health Richland between 2014 and 2019 were included in the study. A retrospective cohort review was conducted to determine the rate of SSI, comparing 2 groups of patients who underwent mandibular fracture repair. Patients who received more than 1 dose of scheduled antibiotics before surgery were compared with those who did not receive any antibiotic treatment before surgery or received only a single dose of antibiotics within 1 hour of incision time (perioperative antibiotics). The primary outcome was the rate of SSI between the 2 groups of patients. There were 183 patients who received more than 1 dose of scheduled antibiotics before surgery and 35 patients who received a single dose of perioperative antibiotics or did not receive any antibiotics. The rate of SSI was not significantly different in the preoperative prophylactic antibiotics group (29.3%) compared with the patients who received a single perioperative dose or no antibiotics (25.0%). Extended regimens of preoperative prophylactic antibiotics beyond a single dose at time of surgery do not reduce SSIs after surgical repair in mandibular fractures.

Mandibular fracture repair techniques in cats: a dentist's perspective.

Feline head trauma injuries are common in general practice, often resulting in mandibular fracture. An understanding of the recent advances in the field of mandibular fracture repair will facilitate evidence-based decision-making in clinical practice. Feline maxillofacial and oral anatomy brings unique challenges in comparison with dogs. It has been commonplace to adapt techniques and equipment that are better suited to other body regions or are species-inappropriate for use in feline maxillofacial surgery, and this has traditionally resulted in high morbidity. This review presents an overview of the diagnosis of, and decison-making for, maxillofacial trauma in cats, specifically with reference to the feline mandible. The challenges associated with the management of these injuries are presented. Techniques for repair that can be employed in general practice, as well as more advanced surgical options, are discussed, as well as the indications for invasive vs non-invasive management. Underutilised methods involving composite dental materials and their versatility for the repair of mandibular fractures in cats, and miniplates for caudal mandibular fractures in cats, are specifically covered, as well as other recent advances in the field, including three-dimensional printing and custom-printed implants. Management of feline facial fractures is an often neglected topic, with very few published studies choosing to focus on head trauma outcomes in cats. Where available, however, this review draws on the published literature, as well as the authors' own clinical experience.

Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures?

PURPOSE: Facial fractures, often resulting from high impact trauma, necessitate surgical fixation with postoperative complications occurring in 3-30% of patients.1 Thus, risk prediction of unfavorable postoperative complications is essential for preoperative planning and postoperative management. Existing literature has linked smoking, alcohol use, age, BMI, and comorbidities to increased risk of adverse postoperative outcomes following facial fracture repair.1 More recently, frailty indices, including the Modified Five-Item Frailty Index (mFI-5) and the Modified Charlson Comorbidity Index (mCCI), have emerged as potentially more accurate predictors of surgical risk and 30-day postsurgical complications than their historical counterparts.2,3 The authors aimed to evaluate whether the mFI-5 and mCCI are stronger predictors of 30-day postoperative complications after open facial fracture reduction, versus historic risk proxies. METHODS: A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed of patients undergoing open facial fracture reduction from 2013-2019. Age, smoking, BMI, comorbidities, and American Society of Anesthesiologists (ASA) class were extracted, and mFI-5 and mCCI scores were calculated using this data. Univariate logistic regressions were performed (p<0.05). RESULTS: A total of 2,667 patients were analyzed, of which 2,131 (80%) were male. Most patients were nonfrail across both indices, with 86% (n=2,292) having an mFI-5 of 0, and 75% (n=1,994) having a mCCI of 0. Both mCCl score ≥2 (OR=2.19, p<0.001) and mFI-5 =1 (OR=1.96, p<0.001) were strong independent predictors of overall 30-day complication rate and complication severity. However, ASA class ≥3 was the strongest predictor (OR=3.60, p<0.001). Age was statically significant, but a low-impact, predictor of complications and complication severity (OR= 1.02, p<0.001). The only significant predictors of surgical site infections (SSI) were smoking (OR=1.56, p=0.042) and ASA class ≥3 (OR=2.37, p=0.013). An mFI-5 of 1 was also found to be a significant predictor of hospital readmission rates (7% vs 3% p<0.001). BMI was not associated with any increased risk. CONCLUSION: The mCCI and mFI-5 are significant independent predicators of total complications and complication severity following facial fracture repair. ASA class ≥3 was the strongest predictor of postoperative complications, likely attributable to concurrent multi-organ system trauma and its global impact on risk in facial fracture injury. An mFI-5 ≥1 was additionally predictive of increased readmission rates. Smoking increased risk of surgical site infections specifically but not overall complications. Newer frailty indices (mFI-5 and mCCI) predicted adverse postsurgical events more strongly than several historic risk proxies, offering potential utility as risk predictors during surgical planning. Further research should continue to clarify their predictive value. REFERENCES: 1. Perez D, Ellis E, 3rd. Complications of Mandibular Fracture Repair and Secondary Reconstruction. Semin Plast Surg. 2020;34(4):225-231. 2. Austin SR, Wong YN, Uzzo RG, Beck JR, Egleston BL. Why Summary Comorbidity Measures Such As the Charlson Comorbidity Index and Elixhauser Score Work. Med Care. 2015;53(9):e65-72. 3. Lee CC, Hunter WP, Hajibandeh JT, Peacock ZS. Does the Modified Frailty Index (mFI-5) Predict Adverse Outcomes in Maxillofacial Fracture Repair? J Oral Maxillofac Surg. 2021.

Therapeutic Efficacy of Adipose-Derived Stromal Vascular Cells for Irradiated Mandibular Fracture Repair

Therapeutic Efficacy of Adipose-Derived Stromal Vascular Cells for Irradiated Mandibular Fracture Repair

Therapeutic Efficacy of Adipose-Derived Stem Cells Versus Bone Marrow Stromal Cells for Irradiated Mandibular Fracture Repair.

Mesenchymal stem cells have immense potential in applications of bone healing and regeneration. However, few studies have evaluated the therapeutic efficacy of adipose-derived stem cells (ASCs) and bone marrow stromal cells (BMSCs) in irradiated bone. The purpose of this study is to compare the ability of ASCs versus BMSCs to enhance healing outcomes in a murine model of irradiated mandibular fracture repair. Forty-eight isogenic male Lewis rats underwent radiation therapy followed by mandibular osteotomy with intraoperative placement of either ASCs or BMSCs. Animals were killed on postoperative day 40. Mandibles were analyzed for union rate, biomechanical strength, vascularity, and mineralization. Groups were compared at P < 0.05 significance. The ASC and BMSC groups demonstrated 92% and 75% union rates. Compared with the BMSC group, the ASC group demonstrated a trending increase in maximum load ( P = 0.095) on biomechanical strength analysis and a significant increase in vessel number ( P = 0.001), vessel thickness ( P = 0.035), and vessel volume fraction ( P = 0.007) on micro-computed tomography angiography analysis. No significant differences in bone mineralization were identified on micro-computed tomography analysis. This study demonstrates the superior therapeutic efficacy of ASCs over BMSCs in irradiated fracture healing as evidenced by union rate, vascular morphometry, and a trend in biomechanical strength. We posit that the robust vascular response induced by ASCs better recapitulates the sequence and synchronicity of physiologic bone healing compared with BMSCs, thereby improving the reliability of irradiated fracture repair.

Medical Nutrition Therapy in Patient With Multiple Fractures, and Liver Injury With Hypoalbuminemia Complications and Moderate Protein Energy Malnutrition: A Case Report

ObjectivesThe mandibular bone is a place of attachment for the muscles of mastication that are actively moving so that it can make it difficult for the patient to carry out the process of chewing food.MethodsA 29 years old male with diagnosis multiple fracture due to a traffic accident. The patient experienced a decrease in oral food worsened 2 days ago because he was difficult to open his mouth due to severe pain when opening his mouth. Looks like a post-surgery wound Mandibular ORIF on the left side of the mandibular region, postoperatively. Exploratory Laparotomy + Liver Repair” in the abdominal. On laboratory examination found the metabolic status Normochromic Normocytic Anemia (11,4), leukocytosis (13,600), thrombocytopenia (143,000), increased NLR (5.42), elevated transaminase enzymes (543/675), Azotemia (1,44), mild hypoalbuminemia (3,0).ResultsMedical nutrition therapy is given gradually according to the patient's eating tolerance, starting from giving 1350 Kcal via oral in the form of semi-liquid food because the patient still has difficulty chewing there until it reaches 2700 Kcal which is assisted by parenteral nutrition. The composition of the macronutrients given. The patient was given oral supplementation in the form of zinc, curcuma, Vitamin A, C, D and snakehead fish extract capsules. The patient was discharged after 12 days of treatment with improved food intake (achieved 100% KET), there was no decrease in anthropometric parameters, the postoperative wound looked dry and improved metabolic status in the form of a decrease in leukocytes towards normal (8.3 × 103/mL), improvement in blood levels platelets (438.000), immune system improvement (1402.9/mL), liver function improvement (43/95), Improvement of kidney function (0.57).ConclusionsOptimal postoperative wound care and adequate medical nutrition therapy with dietary modifications can improve the patient's clinical condition including reducing the inflammatory reaction that occurs and improving the quality of life of patients treated with postoperative repair of mandibular fractures and fractures of the radius/ulna and liver injury due to blunt abdominal trauma.Funding SourcesInstitutions from Department of Nutrition, Faculty of Medicine, Hasanuddin University.

Impact of Age on Surgical Outcomes Following Mandible Fracture Repair.

Open repair of mandibular fractures are frequently performed surgical procedures. Increasing rates of such fractures are seen in older adults following falls. This study assesses the impact of older age on early complications following mandible fracture repair. Retrospective analysis of national registry. The 2013-2018 National Surgical Quality Improvement Program database was queried for all cases of open mandible fracture repair and cases were categorized into younger (18-40), middle (41-65), and older (>65) age cohorts. Demographics and comorbidities were compared between the age groups. Rates of surgical, medical, and wound complications within 30-days of surgery were determined. Multivariable logistic analyses were performed to assess the relationship between age and complications. Altogether, 1818 cases were included for analysis, of which 1269 (69.8%) were younger, 459 (25.2%) were middle, and 90 (5.0%) were older age. Increased rates of complications were seen in the older groups, including unplanned reoperation, unplanned readmission, wound disruption, and medical complications (p < 0.01). On unadjusted analysis, the older (>65) age group had an increased odds of experiencing a complication compared to the younger (18-40) group (OR: 4.19, p < 0.001). The older age group continued to have a significantly increased odds of medical complications after multivariable adjustment (adjusted OR: 8.64, p < 0.001). On this analysis of a national database, advanced age was associated with an increased frequency of early postoperative complications following open mandibular fracture repair. Following multivariable adjustment, advanced age continued to be associated with increased odds of postoperative medical complications within 30 days of surgery. 3 Laryngoscope, 133:287-293, 2023.

Customizable interdental splinting for repair of pediatric mandibular fractures in children with mixed dentition: A novel technique

ObjectiveRepair of pediatric mandibular fractures (PMFs) can be challenging due to the lack of permanent dentition for immobilization, and the presence of unerupted teeth and growth plates in the mandible limiting the space for fixation. Interdental splinting (IDS) has been advocated to provide temporary fixation without the need for mandibular plating; however, there is sparse description of the surgical methodology, and data on long term outcomes are even more limited. The aim of this study is to present our technique and outcomes using a novel technique for IDS repair of pediatric mandible fractures. Study designObservational retrospective chart review. SettingTertiary care pediatric hospital. Subjects and methodsPediatric patients requiring operative repair for mandibular fracture at our tertiary care institution between 2004 and 2021 were included. Patients over 18 years of age, those who died due to associated injuries, or those who underwent non-IDS repairs were excluded. Subjects with at least 3 months of follow-up were assessed for efficacy of surgical repair and short-term adverse outcomes, and at least 1 year for long-term adverse events. Descriptive statistics were obtained. ResultsTwenty-three children were included in the study with an average age of 7.4 years (range 2–17 years). Fifty-two percent (52.2%) were female. The most common fracture site was the condyle, occurring in 16 children (70%). The indication for operative repair in all cases was malocclusion. The average duration of maxillomandibular fixation (MMF) with the novel IDS was 21 days (range 12–42 days). The average length of follow up was 1.6 years (range 3 months–11 years). All children had restored, functional occlusion at follow up with none requiring further orthodontic or dental intervention. Three children of the total cohort (13.0%) had prolonged hospitalization beyond 48 h for poor oral intake. Five children (21.7%) experienced minor long-term complications including persistent temporomandibular joint pain (n = 1, 4.3%), infection (n = 2, 8.7%), hypertrophic scar (n = 1, 4.3%) and exposure of hardware (n = 1, 4.3%). ConclusionPMFs resulting in malocclusion are safely and effectively managed with operative repair utilizing a customizable IDS, with few observed short- and long-term complications.

Mandibular Fracture Repair in Older Adults: Is Age Associated With Adverse Outcomes?

The purpose of this study was to measure the association between age and adverse outcomes in patients undergoing open reduction internal fixation (ORIF) of mandibular fractures. This was a retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program databases (2011 to 2019) to identify patients with mandibular fractures treated with ORIF. The primary predictor variable was age (<45years, 45 to 54years, 55 to 64years, 65 to 74years, and ≥75years). The primary outcome variable was surgical complications. Secondary outcome variables included any complication, extended length of stay (LOS ≥95th percentile), and adverse discharge destination. Covariates included demographic, medical, and perioperative covariates. Descriptive, bivariate, and multiple logistic regression statistics were utilized to evaluate the association between age and adverse outcomes. During the study period, 2,843 patients underwent ORIF of a mandibular fracture, and 2,168 subjects were included. There were 1,673 subjects aged <45years (77.2%), 240 subjects aged 45 to 54years (11.1%), 155 subjects aged 55 to 64years (7.10%), 53 subjects aged 65 to 74years (2.40%), and 47 subjects aged ≥75years (2.20%). A total of 148 subjects (6.83%) experienced a surgical complication; the incidence of surgical complications increased in a step-wise fashion with each decade of life (P≤.001). In bivariate analysis, subjects aged 65 to 74 years were more likely to experience extended LOS (P=.004), whereas subjects aged ≥75years were more likely to have an extended LOS (P≤.001) and an adverse discharge destination (P≤.001). In multivariate analysis, age 65 to 74years was an independent predictor of any complication (P=.032, 95% confidence interval [CI]= 1.08 to 5.37), extended LOS (P=.001, 95% CI= 1.72 to 8.79), and adverse discharge destination (P=.050, 95% CI= 1.00 to 14.4), whereas age ≥75years was an independent predictor of surgical complications (P=.043, 95% CI= 1.03 to 6.68), any complication (P=.018, 95% CI= 1.20 to 6.75), extended LOS (P=.001, 95% CI= 2.35 to 12.3), and an adverse discharge destination (P≤.001, 95% CI= 3.01 to 33.2). The elderly are at increased risk of adverse outcomes with step-wise increases in the odds of select outcomes with increasing age.

Is Outpatient Management of Mandibular Fractures Associated with Inflammatory Complications? An ACS NSQIP Study

PurposeThe timing of mandibular fracture repair has long been debated. Prior studies have suggested that expedited treatment with inpatient admission and repair may improve surgical outcomes, though at an increased cost of care. The purpose of this study was to compare the rates of postoperative inflammatory complications (POICs) in patients with isolated mandibular fractures treated non-urgently using an outpatient protocol versus an urgent inpatient protocol. MethodsThe investigators utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to enroll a national-level, multi-institutional sample of patients with isolated mandibular fractures who underwent open repair between 2011 and 2018. The primary predictor variable was treatment protocol: outpatient (elective) and inpatient (urgent/non-elective). The primary outcome variable was POIC (present/absent) within 30 days. POICs included wound infection, wound dehiscence, sepsis, or septic shock, reoperation, readmission, or death. Other reported complications were deemed non-POICs. Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between treatment protocol and POICs. ResultsThe study sample was composed of 1848 subjects with 1134 in the outpatient group and 714 in the inpatient group. The frequency of POICs were 6.53% and 8.96% for the outpatient and inpatient groups, respectively, with no significant difference between groups (P = .052). However, subjects treated as inpatients were 1.51 times more likely to experience any complication (P = .008) due to an increase in non-POICs (P = .028), in particular urinary tract infections (P = .035). After adjusting for variables associated with POICs in bivariate analysis, including age, hypertension requiring medical treatment, and smoking, classification as ASA II (P = .046, OR = 2.21, 95% CI 1.01-4.83), classification as ASA III (P = .020, OR = 2.88, 95% CI 1.18 -7.02), diabetes (P = .004, OR = 3.11, 95% CI 1.43-6.74), and preoperative hematocrit (P = .010, OR = .950, 95% CI 0.913-0.988) were independent predictors of POICs in the regression model. Length of stay was 0.83±2.61 days compared to 2.36±3.63 days for the outpatient and inpatient groups, respectively (P ≤ .001). ConclusionThere was no significant difference in POICs between patients treated as outpatients versus inpatients, though outpatients had fewer non-POICs and a 1.53-day shorter duration of hospital stay. Greater ASA status, diabetes, and lower preoperative hematocrit were independent risk factors for POICs. These data could be useful for institutions seeking to reduce the cost of mandibular fracture repair without compromising the rate of short-term POICs. It may also be relevant for surgeons practicing outside tertiary care centers where an outpatient treatment protocol could make management of mandibular fractures more feasible.

125 The Fate of The Third Molar in The Line of a Mandibular Angle Fracture: A Retrospective Study at A Tertiary Centre

Abstract Aim: To evaluate the risk of complications associated with retaining or extracting an asymptomatic third molar in the line of an angle fracture. Aiming to seek a consensus whether third molars should be extracted or retained during surgical repair of mandibular angle fractures. Method A retrospective study was undertaken at the Queen Elizabeth Hospital, Birmingham. 150 patients across a span of three years underwent open reduction and internal fixation of mandibular angle fractures with third molar involvement. Patients were classified into two groups, tooth retention during angle fracture and tooth removal during angle fracture repair. Hospital records were evaluated to seek the rate of post-operative complications at follow-up Results 162 angle fractures were identified with ipsilateral wisdom teeth present. In 37 cases the wisdom tooth was removed during surgery. 6 complications (16.2%) occurred in this group necessitating a return to theatre. In 125 cases the wisdom tooth was left in-situ. Complications necessitating a return to theatre occurred in 14 cases (11.1%). Conclusions This study indicates that retention of wisdom tooth overall did not significantly increase the risk of complications associated with angle fractures (p = 0.42). Where wisdom tooth pathology was noted its retention was associated with complications requiring a return to theatre (X2=4.40, p = 0.036).

Is Outpatient Management of Mandibular Fractures Associated With Inflammatory Complications? An ACS-NSQIP Study

Timing of mandibular fracture repair has long been debated. The purpose of the present study was to assess the incidence of postoperative inflammatory complications (POICs) following open repair of mandibular fractures managed non-urgently in the outpatient setting versus urgently in the inpatient setting. The authors utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to enroll a sample of patients with mandibular fractures who underwent open repair. The primary independent variable was treatment protocol: outpatient (elective) versus inpatient (urgent/non-elective). The primary dependent variable was POIC (yes/no). Descriptive, bivariate, and multiple logistic regression statistics were utilized to evaluate the relationship between treatment protocol and POICs. The study cohort was comprised of 1,848 subjects with 1,134 outpatients and 714 inpatients. The incidence of POICs was 6.53% for the outpatient group compared to 8.96% for the inpatient group, with no significant difference between groups (P= .052). However, subjects treated as inpatients were 1.51 times more likely to experience any complication (P=.008) due to an increase in non-POICs (P=.028), in particular urinary tract infections (P=.035). After adjusting for age, hypertension requiring medical treatment, and smoking, classification as ASA II (P=.046, OR=2.21, 95% CI 1.01 to 4.83), ASA III (P=.020, OR=2.88, 95% CI 1.18 to 7.02), diabetes (P=0.004, OR=3.11, 95% CI 1.43 to 6.74), and preoperative hematocrit (P=0.010, OR=0.950, 95% CI 0.913 to 0.988) were independent predictors of POICs. Length of stay was 0.83 ± 2.61 days compared to 2.36 ± 3.63 days for the outpatient and inpatient groups, respectively (P ≤ .001). There was no significant difference in POICs between patients treated as outpatients versus inpatients, though outpatients had fewer non-POICs and a shorter length of hospital stay.