Complicaciones De Fx Mandibular

J Oral Maxillofac Surg 68:2484-2488, 2010

Comparison of Treatment Outcomes Associated With Early Versus Late Treatment of Mandible Fractures: A Retrospective Chart Review and Analysis
Mario Lucca, DMD,* Kalpakam Shastri, DMD, FDRCSI,† William McKenzie, BM,‡ James Kraus, DMD,§ Matthew Finkelman, PhD, and Richard Wein, MD¶
Purpose: We conducted outcomes assessment for all patients who hadundergone treatment of

mandible fractures at Tufts Medical Center across the 2 specialties of oral and maxillofacial surgery and otolaryngology. The aim of the present study was to determine whether a correlation existed between the development of postoperative complications and late treatment of mandible fractures (defined as treatment provided 48 hours after the time of injury). Patients andMethods: All patients with mandible fractures treated at Tufts Medical Center between January 1, 2003 and January 1, 2008, underwent chart review to document the relevant data, including the time of fracture, time of treatment, and complications recorded during postoperative follow-up. The only patients included in the review were those who had follow-up data with good documentation. Results: Ourdataset included 92 patients, with a mean age of 28.74 years. The injury scores, compared between the early and late treatment and complication and noncomplication groups, were equivocal. Of our 92 treated patients, 19 (20.7%) had 1 postoperative complication. Of the 19 patients with any complication, 10 had undergone early treatment and 9 had been treated after 48 hours. Of our late treatment group,25% developed 1 complication. The overall complication rate for the early group was 18%. Conclusions: Our study did not reveal a statistically significant difference in the development of postoperative complications after mandible fracture repair between the early and late treatment groups. Our study seemed to have a result similar to that of some of the earlier studies investigating the samevariable. © 2010 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68:2484-2488, 2010 Mandible fractures are commonly treated by maxillofacial surgeons. In our specialty, mandible fractures are one of the common facial fractures in the adult population.1 However, the timing of treatment of mandible fractures remains a source of debate. All mandible fractures through thedentoalveolar areas are considered open fractures because of the potential for communication through the periodontal ligament space. Although some clinicians believe that mandibular fractures benefit from immediate care, others prefer to delay treatment,
*Chief Resident, Department of Oral and Maxillofacial Surgery, Tufts University, Boston, MA. †Adjunct Assistant Professor, Department of Oral andMaxillofacial Surgery, Tufts University, Boston, MA. ‡Fourth-Year Dental Student, Tufts University, Boston, MA. §Chief Resident, Department of Oral and Maxillofacial Surgery, Tufts University, Boston, MA. Assistant Professor, Tufts University School of Dental Medicine, Boston, MA.

especially if faced with difficult logistics in obtaining operating room time. The published data have been equallyinconclusive regarding the timing of mandible fracture repair. Although some investigators have considered fractures older than 72 hours to be de facto acute osteomyelitis, others have noted no statistically significant difference in complication rates between fractures treated within a 12-hour period and those treated after 3 to 4 days.2-4 The discrepancy in the published data has created a problemwhen
¶Assistant Professor, Department of Otolaryngology/Head and Neck Surgery, Tufts Medical Center, Boston, MA. Address correspondence and reprint requests to Dr Lucca: 1 Kneeland Street, 5th Floor, Boston, MA 02111; e-mail: mariolucca@ yahoo.com
© 2010 American Association of Oral and Maxillofacial Surgeons

0278-2391/10/6810-0016$36.00/0 doi:10.1016/j.joms.2010.01.024

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