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Non-surgical management of non-condylar mandibular fractures

Published:August 28, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.07.014

      Abstract

      Unlike fractures of the remaining facial skeleton, fractures of the non-condylar part of the mandible are invariably treated surgically, with the potential risk of further iatrogenic injury. There is, however, a substantial evidence gap pertaining to the potential non-surgical management of such injuries. The aim of this study was to determine the outcomes of mandibular fractures treated with non-surgical management. All patients with mandibular fractures who were referred to a large regional major trauma service over a one-year period (1 January–31 December 2021) were identified. Those treated with surgery or who sustained fractures of the condylar portion of the mandible were excluded. Of all the patients referred to our unit with mandibular fractures, 34/155 (22%) underwent non-surgical management. In all cases plain radiographs demonstrated minimal displacement. Thirty-two (94%) fractures were unilateral, of which 24 (70%) involved the angle. Two of 34 patients subsequently required open reduction and internal fixation due to pain that did not improve over time, one of whom declined. A minimally extruded tooth in the fracture line, which altered the occlusion in one additional patient, required minimal reduction of the enamel. The remaining patients healed without complication six weeks after injury. Non- surgical management requires careful case selection and regular follow up, so is of value to only a small proportion of patients. Twenty-two per cent of all mandibular fractures were managed non-surgically at our unit in one year, with a 97% success rate, demonstrating the potential utility of this strategy in carefully selected cases.

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      References

        • Reddy L.
        • Lee D.
        • Vincent A.
        • et al.
        Secondary management of mandible fractures.
        Facial Plast Surg. 2019; 35: 627-632
        • Bodner L.
        • Amitay S.
        • Joshua B.Z.
        Clinical outcome of conservative treatment of displaced mandibular fracture in adults.
        Surg Sci. 2013; 4: 500-505
        • Krishnan B.
        The role of a conservative minimal interventional management protocol in the fractures of the dentate portion of the adult mandible.
        Craniomaxillofac Trauma Reconstr. 2016; 9: 20-28
        • Ahmed A.
        • Wu E.
        • Sarai R.
        • et al.
        Potentially modifiable patient factors in mandible fracture complications: a systematic review and meta-analysis.
        Br J Oral Maxillofac Surg. 2022; 60: 266-270
        • Alexander M.
        • Mishra R.
        Conservative management of mandibular fractures—a prospective study.
        Int J Oral Maxillofac Surg. 2007; 36: 1075
        • Forrester J.D.
        • Wolff C.J.
        • Choi J.
        • et al.
        Surgical Infection Society guidelines for antibiotic use in patients with traumatic facial fractures.
        Surg Infect (Larchmt). 2021; 22: 274-282
        • Dawoud B.E.
        • Kent S.
        • Henry A.
        • et al.
        Use of antibiotics in traumatic mandibular fractures: a systematic review and meta-analysis.
        Br J Oral Maxillofac Surg. 2021; 59: 1140-1147
        • Milic T.
        • Raidoo P.
        • Gebauer D.
        Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review.
        Br J Oral Maxillofac Surg. 2021; 59: 633-642
        • Hurrell M.J.
        • David M.C.
        • Batstone M.D.
        Patient compliance and mandible fractures: a prospective study.
        Int J Oral Maxillofac Surg. 2019; 48: 759-768
        • Raikundalia M.
        • Svider P.F.
        • Hanba C.
        • et al.
        Facial fracture repair and diabetes mellitus: an examination of postoperative complications.
        Laryngoscope. 2017; 127: 809-814
        • Balasundram S.
        • Kovilpillai F.J.
        • Royan S.J.
        • et al.
        A 4-year multicentre audit of complications following ORIF treatment of mandibular fractures.
        J Maxillofac Oral Surg. 2020; 19: 289-297