Operative Techniques in Mandibular Fracture Repair: A Cross-specialty Comparison of Plastic and Reconstructive Surgery, Otolaryngology, and Oral and Maxillofacial Surgery.

BACKGROUND

Mandibular fractures are the most common facial fractures treated in the emergency setting, with significant variability in operative management across surgical specialties. Plastic and reconstructive surgery (PRS), otolaryngology (ENT), and oral and maxillofacial surgery (OMFS) each approach mandibular fracture repair with different philosophies, particularly regarding tooth extraction within the fracture line. However, few studies directly compare these practices.

OBJECTIVE

This study assessed differences in operative techniques, specifically tooth extraction and fixation strategies, across PRS, ENT, and OMFS in the treatment of isolated mandibular fractures at a level 1 trauma center.

METHODS

Following institutional review board approval, a retrospective chart review was conducted at Regional One Health from May 2019 to May 2020. Ninety patients with isolated mandibular fractures were identified using relevant Current Procedural Terminology codes. Statistical analysis included χ2 and analysis of variance testing with significance set at P < 0.05.

RESULTS

Among 90 patients (80% male; mean age, 33 years), assault was the leading cause of injury. These cases were managed by 3 specialties: ENT (24 patients), PRS (24 patients), and OMFS (42 patients). All 3 specialties utilized MMF and ORIF with similar frequency. However, OMFS demonstrated significantly higher tooth extraction rates (50%) compared with ENT (8%) and PRS (4%) (P < 0.00005). ENT had the longest average time to surgery (9 days) compared with PRS (2 days) and OMFS (1 day). No significant differences were observed in reoperation rates, operative duration, or hospital stay among the specialties.

CONCLUSIONS

Significant differences were identified in the frequency of surgical tooth extractions and time to operation for mandibular fracture repairs across different specialties. These differences may impact resource allocation and patient outcomes. Further research is needed to explore the origins of these variations and their long-term effects.