Are open mandibular fractures still an emergency?

Rev Stomatol Chir Maxillofac Chir Orale. 2015 Nov;116(5):285-8. doi: 10.1016/j.revsto.2015.04.009. Epub 2015 Jul 10.

Abstract

Introduction: Early surgical management is often advocated for fractures of the tooth-bearing portion of the mandible. A 6-hour delay has been mentioned for the fixation of these fractures. Our aim was to bring this paradigm into question.

Methods: All patients referred to our department from September 2012 to May 2014 for fractures of the tooth-bearing portion of the mandible were retrospectively included. For each patient, age, gender, aetiology of the fracture, and characteristics of the fractures were recorded. Tobacco and/or alcohol addictions, diabetes and mandibular dental condition were taken into account. We also noticed the preoperative delay and the occurrence of complications such as: haematoma, infection, wound dehiscence, osteosynthesis failure and pseudarthrosis.

Results: Among the 47 patients referred, 36 were treated with a delay of more than 6 hours (76.6%). In 88.8% of the cases, the reason for this delay was unavoidable. The mean delay time from trauma to surgery was 52 hours (range: 7-312). Forty-nine percent of the patients had comorbidities. Complications occurred in 6 patients leading to an overall complication rate of 16.67%. A statistically significant higher complication rate was observed among smokers (P=0.006). No statistical relationship was found between the delay and the occurrence of complications (P=0.994). This study suggests that fractures of the tooth-bearing portion of the mandible should no longer be considered as an emergency that must be treated within a 6-hour delay.

Keywords: Complications; Délai au traitement; Fractures mandibulaires; Mandibular fractures; Maxillomandibular fixation; Time-to-treatments.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Emergencies / epidemiology
  • Female
  • Fracture Fixation, Internal / methods
  • Fracture Fixation, Internal / statistics & numerical data
  • Fractures, Open / epidemiology
  • Fractures, Open / surgery*
  • Humans
  • Jaw Fixation Techniques / statistics & numerical data
  • Male
  • Mandible / surgery
  • Mandibular Fractures / epidemiology
  • Mandibular Fractures / surgery*
  • Mandibular Injuries / epidemiology
  • Mandibular Injuries / surgery*
  • Middle Aged
  • Retrospective Studies
  • Young Adult