Is fixation of mandible fractures urgent?
Background: There are conflicting reports on the urgency of fixing mandible fractures. While some recommend fixation within the first 72 hours, others claim that repairs that are made as late as five days post-injury do just as well. Although delayed repair can be associated with compromised nutrition, poor hygiene, inflammation, scarring and contamination, a delay can also mean diminished facial swelling and facilitated exposure.
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May 2011Study design: Literature review.
Synopsis: The authors reviewed five articles, two from The Laryngoscope and one each from Plastic and Reconstructive Surgery, Journal of Oral and Maxillofacial Surgery and Dental Traumatology. A study by Maloney and colleagues found that low infection rate was partly due to the timing of repair, i.e., within the first 72 hours (Oral Maxillofac Surg. 2001;59:879–884). Biller and colleagues noted a significantly greater rate of technical complications in a delayed treatment group (Laryngoscope. 2005;115:769–772).
Outcomes were not impacted with a delay in repair, however, according to studies by Czerwinski and colleagues (Plast Reconstr Surg. 2008;122(3):881-885), Furr and colleagues (Laryngoscope. 2006;116(3):427-430) and Hermund and colleagues (Dent Traumatol. 2008;24(1):22-26).
The authors recommended a randomized study to allow an accurate comparison of outcomes but noted that this is unlikely to be achieved.
Bottom line: At present, there is no evidence confirming that immediate repair is necessary for better outcomes with mandible fractures.
Citation: Barker DA, Park SS. Is fixation of mandible fractures urgent? Laryngoscope. 2011;121(5):906-907.
—Reviewed by Sue Pondrom