Complications and Reoperations in Mandibular Angle Fractures. JAMA Facial Plast Surg 2018 May 01;20(3):238-243
Date
01/06/2018Pubmed ID
29302682Pubmed Central ID
PMC5876800DOI
10.1001/jamafacial.2017.2227Scopus ID
2-s2.0-85047750451 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
IMPORTANCE: Mandible angle fractures can be repaired in a variety of ways, with no consensus on the outcomes of complications and reoperation rates.
OBJECTIVES: To analyze patient, injury, and surgical factors, including approach to the angle and plating technique, associated with postoperative complications, as well as the rate of reoperation with regard to mandible angle fractures.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study analyzing the surgical outcomes of patients with mandible angle fractures between January 1, 2000, and December 31, 2015, who underwent open reduction and internal fixation. Patients were eligible if they were aged 18 years or older, had 3 or less mandible fractures with 1 involving the mandibular angle, and had adequate follow-up data. Patients with comminuted angle fractures, bilateral angle fractures, and multiple surgical approaches were excluded. A total of 135 patients were included in the study. All procedures were conducted at a single, large academic hospital located in an urban setting.
MAIN OUTCOMES AND MEASURES: Major complications and reoperation rates. Major complications included in this study were nonunion, malunion, severe malocclusion, severe infection, and exposed hardware.
RESULTS: Of 135 patients 113 (83.7%) were men; median age was 29 years (range, 18-82 years). Eighty-seven patients (64.4%) underwent the transcervical approach and 48 patients (35.6%) received the transoral approach. Fifteen (17.2%) patients in the transcervical group and 9 (18.8%) patients in the transoral group experienced major complications (difference, 1%; 95% CI, -8% to 10%). Thirteen (14.9%) patients in the transcervical group and 8 (16.7%) patients in the transoral group underwent reoperations (difference, 2%; 95% CI, -13% to 17%). Active smoking had a significant effect on the rate of major complications (odds ratio, 4.04; 95% CI, 1.07 to 15.34; P = .04).
CONCLUSIONS AND RELEVANCE: During repair of noncomminuted mandibular angle fractures, both of the commonly used approaches-transcervical and transoral-can be used during treatment with equal rates of complication and risk of reoperation. For a patient undergoing surgery for mandibular angle fracture, smoking status is more likely to predict surgical outcomes rather than how the surgeon chooses to approach and fixate the fracture.
LEVEL OF EVIDENCE: 3.
Author List
Chen CL, Zenga J, Patel R, Branham GAuthor
Joseph Zenga MD Assistant Professor in the Otolaryngology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Female
Fracture Fixation, Internal
Humans
Male
Mandibular Fractures
Middle Aged
Postoperative Complications
Reoperation
Treatment Outcome
