Impact of Surgical Timing on Postoperative Complications Following Open Reduction Internal Fixation of Mandibular Fractures

SDCC 

Purpose:
The mandible is the second most fractured facial bone. While closed reduction via mandibulomaxillary fixation (MMF) is therapeutically beneficial, open reduction internal fixation (ORIF) has become the standard of care for the treatment of mandibular fractures. Timing of ORIF has evolved through time and has been a subject of debate for decades. Existing research investigating the association between timing of ORIF and postoperative complications is characterized by small sample sizes and yields conflicting recommendations regarding early vs delayed surgical intervention (Reference 1). Our study aimed to investigate the association between timing of ORIF and the incidence of postoperative complications.
Methods:
We conducted a retrospective cohort study of trauma patients who underwent mandibular fracture repair in 2018 and 2019. Excluded were patients <18 years old, those who underwent MMF only, and those with postoperative follow-up <2 weeks. The primary outcome was the incidence of postoperative complications following ORIF. The duration between injury and ORIF was categorized into: 1-3, 4-7, 8-14, and >14 days. The association between surgical timing categories and the incidence of postoperative complications was assessed using bivariate analyses and multivariate logistic regression.
Results:
Of n=226 patients included, median (IQR) age was 32 (25-42) years, and median (IQR) follow up was 49 (25-118) days. The majority of patients (n=207 [92%]) underwent both ORIF and MMF. Most patients had early ORIF within 3 days of injury (n=168 [74%]). Figure 1 shows the distribution of ORIF procedures by days from injury to surgery. Major postoperative complications included unplanned reoperation (n=25 [11.1%]), malocclusion (n=20 [8.8%]), and malunion (n=7 [3.1%]). Minor postoperative complications included jaw pain (n=91 [40.3%]), mental nerve paresthesia (n=79 [35%]), infection (n=30 [13.3%]), temporomandibular joint complications (n=17 [7.5%]), and wound dehiscence (n=14 [6.2%]). After controlling for potential confounders of the association between timing of ORIF and postoperative complications e.g., mechanism of injury, past medical history, and mandibular fracture site, delayed ORIF beyond 2 weeks of injury was associated with significantly greater odds of malunion (aOR [95% CI] 17.9 [1.9->100], P=0.012) and unplanned reoperation (aOR [95% CI] 5.8 [1.3-26], P=0.023). Delayed ORIF 8-14 days after injury was associated with significantly greater odds of malocclusion (aOR [95% CI] 14.5 [1.8->100], P=0.012).
Conclusion:
The timing of ORIF following mandibular fracture is a critical factor in postoperative outcomes. Delayed ORIF beyond 1 week of injury was significantly associated with greater odds of postoperative complications. Our findings underscore the importance of timely ORIF in the management of mandibular fractures to minimize the risk of postoperative complications.

Reference:
1. Stone N, Corneman A, Sandre AR, Farrokhyar F, Thoma A, Cooper MJ. Treatment Delay Impact on Open Reduction Internal Fixation of Mandibular Fractures: A Systematic Review. Plast Reconstr Surg Glob Open. 2018 Jun 18;6(6):e1829. doi: 10.1097/GOX.0000000000001829.

Craniomaxillofacial/Head and Neck

PSTM 2024