Factors associated with long-term complications after repair of mandibular fractures

Educational Objective: At the conclusion of this paper, the participants should be able to identify, compare, and discuss the natural history of complications of mandible fractures and repair. Objectives: To analyze factors affecting the incidence of long-term complications after the repair of mandible fractures. To determine whether the use of antibiotics at any time in the course of treatment impacted the development of complications. Study Design: Retrospective medical record review. Methods: Medical records for patients with mandibular fractures treated surgically over a 5 year period were reviewed for demographics, history of substance abuse, etiology, location of fracture, any associated facial injury, type and timing of repair, pre-, peri-, and postoperative antibiotic treatment, length of hospitalization, and lag time to repair. The development of infectious and other complications after surgery, specifically, the development of abscesses, fistulae, mal/nonunion, hardware exposure, or extrusion, were recorded. Results: Of 273 subjects, 56 fractures were repaired using open reduction internal fixation (ORIF) alone, 112 mandibulomaxillary fixation (MMF), and 105 with a combination of MMF and ORIF. Eighteen (6.6%) patients developed an infectious or related long-term complication. These included abscess (n = 4), infected hardware (n = 1), mal/nonunion (n = 8), and hardware exposure/extrusion (n = 9). Smoking and alcohol abuse (P = .021) and the use of plating techniques (P = .04) correlated with a higher incidence of long-term complications. Patient age, sex, location and etiology of fracture, associated facial injury, lag time to repair, length of hospitalization, and the use of antibiotics at any time after injury or repair were unrelated to the development of complications. Conclusions: The development of infection, nonunion, and related complications after the repair of mandibular fractures correlates with a history of tobacco and alcohol use and ORIF of multiple fractures, but there were no statistically significant relationships to patient demographics, fracture site, lag time to repair, length of hospitalization, or the use of antibiotics. In this series, antibiotic therapy appears to have had no impact on the development of postoperative complications. Key Words: Antibiotics, complications, infection, mandible fracture.