Impact of Surgical Timing on Postoperative Complications Following Open Reduction Internal Fixation of Mandibular Fractures.

PURPOSE: The mandible is the second most fractured facial bone. The timing of open reduction internal fixation (ORIF) has been a subject of debate for decades. The authors sought to investigate the association between the timing of ORIF and the incidence of postoperative complications.

METHODS

The authors retrospectively reviewed adult trauma patients who underwent ORIF in 2018 and 2019. The authors excluded patients who underwent mandibulomaxillary fixation (MMF) only and those with postoperative follow-up <2 weeks. The duration between injury and ORIF was categorized into: <4, 4 to 7, and >7 days. The association between surgical timing categories and the incidence of postoperative complications was assessed using bivariate analyses and multivariable logistic regression.

RESULTS

Of 226 patients included, the median (interquartile range) age was 32 (25-42) years, and the median (interquartile range) follow-up was 49 (25-118) days. Most patients [207 (92%)] underwent both ORIF and MMF. Most patients had ORIF within 3 days of injury [168 (74%)]. Major postoperative complications included unplanned re-operation [n=25 (11.1%)], malocclusion [n=20 (8.8%)], and malunion [n=7 (3.1%)]. Minor postoperative complications included mental nerve paresthesia [n=79 (35%)], infection [n=30 (13.3%)], TMJ complications [n=17 (7.5%)], and wound dehiscence [n=14 (6.2%)]. Delayed ORIF >7 days of injury was associated with significantly greater odds of unplanned re-operation [adjusted odds ratio (aOR) 95% CI 10.43 (2.16-50.44), P =0.004], malocclusion [aOR (95% CI) 8.17 (1.31-51.03), P =0.025], and malunion [aOR (95% CI) 23.04 (1.18->10), P =0.039].

CONCLUSION

The authors recommend early ORIF in the management of mandibular fractures to minimize postoperative complications.