The Effect of Mandibular Fracture Treatment on Nutritional Status

Surgeons treating facial trauma are faced with a dilemma: fracture healing requires tremendous energy expenditure by the body yet the treatments for mandibular and maxillary fractures commonly include dietary limitations. Despite this, there are almost no studies that attempt to quantify the effect of surgical and non-surgical fracture treatments on the body’s nutritional status. The purpose of the present study is to begin to address these gaps in knowledge that may help inform surgeons and patients about the treatments for facial fractures. The investigators hypothesize that there will be a fraction of patients with mandibular fractures with pre-existing nutritional deficiencies and that a majority of patients will develop objective signs of a decline in nutritional status during the treatment period, as measured by BMI and weight. The aim of this study is to describe the amount of patients presenting with mandible fractures and pre-existing body mass index (BMI) of less than 20 and to quantify the decrease in weight throughout the course of their treatment.

Patients were found through the medical records department using the relevant ICD-9 codes from 8/1/2012 to 4/30/15. The patients were then selected for inclusion according to the following criteria: mandible fracture and had at least one follow up visit with 4 weeks of the fracture. Descriptive statistics were reported and the student’s t test was used where appropriate.

There were 446 patients that met the inclusion criteria during the study period. The average BMI when height and weight were first recorded for patients included in the study was 24.9 ± 4.5. Patients who had a BMI of less than 20.0 comprised 9.2% of the study population. Over the course of their treatment, patients lost an average of 10.5 ± 14.1 pounds (4.8 ± 6.4 kg). Approximately 82.1% of patients lost weight during their treatment. The point of greatest weight loss was at 31.6 ± 22.6 days. There was no difference in weight loss between open reduction and closed reduction treatment techniques (p= .417).

During the course of treatment for mandibular fractures, patients experienced moderate weight loss, indicating a decline in their nutritional status. Additionally, we found that a portion of patients (9.2%) presented with pre-existing evidence of poor nutritional status. Numerous studies in the orthopedic literature have demonstrated the adverse effect of malnutrition on mortality, complications, length of stay, and return to pre-morbid functioning in certain patient populations, such as elderly patients with hip fractures. While most patients with facial fractures are relatively young and healthy, the extent of their dietary limitation is great. The weight loss recorded in this study demonstrates a clear decline in nutritional status over the course of treatment. However, whether the weight loss or pre-existing deficits in nutritional status affect the successful outcomes of mandibular fractures is currently unknown.

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