Mandibular Fracture Complication Rates Between Acute Vs Delayed Treatment

Statement of the Problem: 

The purpose of this preliminary study was to investigate if there is a correlation between the time-span from injury to surgical intervention against the incidence of post- operative complications and the duration of intra-operative time at Loma Linda University Medical Center and East Campus treated by the Oral and Maxillofacial Surgical team. Controversy exists for determining whether early intervention would decrease post operative complications and reduce operatory time. We sought to pilot a study at Loma Linda University to examine this conflict between acute (early) and delayed timing to surgically repair mandibular fractures. 

Materials and methods: 

The retrospective study followed a cohort of 37 subjects that were selected from the patient pool of the Loma Linda University Oral and Maxillofacial Surgery Department who were treated for mandibular fractures between the years 2013 and 2014. Medical records, dental records, radiographs and operatory notes were used to collect the data for analysis. The injury to surgical intervention interval was collected from the resident notes in the medical records and time stamp of the operatory notes. The complication factors that were accounted for were post- operatory infections, malocclusion, -union, and nerve injury. The study then took a summation of post operative complications for each subject and showed that they either presented with a total of zero, one, or two complications. Data for the duration of surgery were taken from the operatory notes where the start and end times of the procedure were reported. 

Sample size: 37 subjects

Duration: 2 years 

Statistical methods: Nonparametric tests were run with the criteria of alpha level =0.05 and CI = 95 and the correlation was set to be significant at the 0.01 level (2-tailed).

Results 

The pilot sample size (n=37) was used for analysis of this preliminary study. The primary hypothesis was tested first which, looked at the injury-surgery interval in days against the total number of complications. The results showed that there is no correlation between the two variables (Spearman’s rho= -.069, P= .687) and failed to reject the null hypothesis. An analysis was run for correlation between duration of surgery and injury-surgery interval and the results showed no correlation between these two variables (Spearman’s rho = -.122, P= .471). An analysis for correlation between duration of surgery (minutes) against the total complications was done to examine if a relationship between these two variables were present. The analysis showed that there is statistically significant correlation between these two variables (Spearman’s rho = .477, P= .006).

Conclusions  

The preliminary results failed to reject the null hypothesis, indicating that in spite of generally accepted principles, waiting to repair mandibular fractures does not result in a higher rate of complications or longer intra-operative time. The results of the study could have large implications to current timeline protocols of treatments of mandibular fractures. However, due to our small sample size (n= 37), further investigation is necessary. We did, however find a significant correlation between the duration of the operation and the rate of complications. Although this finding was not part of the original study, the results indicate that longer operatory times may  be predictive for increased rates of complications. With this finding, more attention to post-operative care should be provided for patients who had longer operatory times than those who had shorter operatory times.

Referances 

1) Furr AM1, Schweinfurth JM, May WL. Factors associated with long-term complications after repair of mandibular fractures. Laryngoscope. 2006 Mar;116(3):427-30.

2) Gazal G1. Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Almadinah Almunawwarah, Saudi Arabia. Evaluation of the effectiveness of early or delayed treatment upon healing of mandibular fractures: A retrospective study.Eur J Dent. 2015 Jan-Mar;9(1):87-91. doi: 10.4103/1305-7456.149650