Treatment and complications of mandibular fractures: A 10-year analysis

Abstract

The surgical treatment and complications of patients with mandibular fractures in Amsterdam over a period of 10 years are analysed. Between January 2000 and January 2009 225 patients were surgically treated for a mandibular fracture (mean age of 32.6 (SD ± 14.6) years). A total of 426 fracture lines were identified. Of 213 dentate patients 29 patients were treated primarily with intermaxillary fixation (IMF). IMF combined with osteosynthesis was performed on 99 patients. Seventy-nine patients received IMF only per-operatively to make open reduction and internal fixation (ORIF) possible. Of 12 edentulous patients three patients were treated with Gunning splints. Nine patients were treated by manual reduction and internal fixation. A total of 1965 screws and 442 plates were used. Sixty (26.7%) patients presented with complications, including (transient) hyposensibility of the lip and chin (34 patients), dysocclusion (15 patients), infected osteosynthesis material (six patients) and temporomandibular dysfunction (five patients). Four patients needed surgical retreatment for correction of a dysocclusion. The results of this report are partly in line with other studies and provide important data for improving the treatment of the fractured mandible.

Introduction

Mandibular fractures have caused significant management problems for maxillofacial surgeons for many years (Chen et al., 2011). Restoring a pretraumatic occlusion is the common aim for optimalisation of masticatory function (Seemann et al., 2010a). Reduction of compression of sensory nerves can be accomplished. The location of the fracture determines the surgical treatment and the decision for either closed reduction or open reduction with internal fixation (ORIF) (de Matos et al., 2010, Park et al., 2010, Seemann et al., 2010b).

Different treatment modalities for managing a mandibular fracture have been described by several authors. Although in the past fractures of the mandibular body, ramus or angle were treated with closed reduction and intermaxillary fixation (IMF) currently the state of art is to stabilize these fractures by open reduction and fixation with osteosynthesis material (Iatrou et al., 1998, Iatrou et al., 2010, Sauerbier et al., 2008). A fracture of the condyle can be treated conservatively with IMF (Chen et al., 2011, Park et al., 2010) or surgically by an open reduction using a submandibular, preauricular, retroauricular or transparotid approach (Park et al., 2010, Seemann et al., 2011) or by a transoral approach or endoscopically (Mueller et al., 2006, Park et al., 2010).

The diversity in treatment options results in many treatment-related complications (Seemann et al., 2011). The overall complication rate for all mandibular fractures is reported to be 9–36% (Bell and Wilson, 2008, Bormann et al., 2009, Ellis, 1999, Fox and Kellman, 2003, Jing et al., 2011, Park et al., 2010, Seemann et al., 2010b).

Post-operative complications are related to the type of fracture, dislocation or displacement, uni-/bilaterality, other additional fractures of the mandible/maxilla and the chosen surgical treatment (Zachariades et al., 2006). Common complications described are mandibular asymmetry, temporomandibular joint pain, dysocclusion, (transient) facial nerve paresis, wound infection, osteosynthesis failure and pseudarthrosis (Burm and Hansen, 2010, Chen et al., 2011, Ellis, 1998, Marker et al., 2000, Park et al., 2010, Seemann et al., 2010a, Seemann et al., 2011). The need for a secondary operative intervention is rare but sometimes necessary, mainly to correct a dysocclusion.

This study was performed to analyse the diagnosis, treatment and complications of mandibular fractures surgically treated in a Dutch population.