Northeastern Society of Plastic Surgeons

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Risk Factors for Postoperative Complications Following Mandibular Fracture Repair
Eric Resnick*, Bashar Hassan, Seray Er, Pharibe Pope, Gregory Lamaris, Michael Grant, Judy Pan
Department of Plastic Surgery, University of Maryland School of Medicine, Arnold, MD

Background: Complications following mandibular fracture repair (MFR) may carry significant morbidity to patients. The purpose of our study is to determine the risk factors for postoperative complications following MFR.
Methods: We conducted a retrospective cohort study of trauma patients who underwent MFR in 2018-2019. Excluded were patients <18 years old and those with postoperative follow-up <2 weeks. Demographics, mandibular fracture characteristics, and postoperative complications were reported. The mandibular injury severity score (MISS) of each patient was calculated. Bivariate analysis and multivariate logistic regression were performed.
Results: Of n=275 patients included, mean (SD) age was 35 (14) years and median (IQR) follow up was 49 (26-117) days. Most patients (n=208 [76%]) underwent both maxillomandibular/intermaxillary fixation (MMF/IMF) and open reduction and internal fixation (ORIF). The incidence of major postoperative complications was 19% (n=51) including malunion (n=8 [2.9%]), malocclusion (n=21 [7.6%]), and reoperation (n=26 [9.5%]). The incidence of minor postoperative complications was 61% (n=167) including jaw pain (n=108 [39.3%]), mental nerve paresthesia (n=85 [30.9%]), infection (n=31 [11.3%]), TMJ complications (n=29 [10.6%]), restricted maximal intercisal opening (n=15 [5.5%]), hardware loosening or exposure (n=15 [5.5%]) and wound dehiscence (n=14 [5.1%]). Alcohol use at the time of surgery and greater MISS were associated with greater odds of major complications (adjusted odds ratio [aOR] 95% confidence interval [95% CI] 3.4 [1.2-9.0], 1.09 [1.02-1.16], respectively. Smoking at the time of surgery and moderate-to-severe fracture displacement (>2 mm) were associated with greater odds of minor complications (aOR [95% CI] 2.1 [1.04-4.2], 2.7 [1.2-6.4], respectively).
Conclusion: Alcohol use, smoking, greater MISS score, and displaced fractures >2 mm were significant risk factors for postoperative complications following MFR. Our findings can help guide informed decision making and surgical planning in patients with mandibular fractures.

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