This is a prospective study from Brisbane of 215 patients with a total of 359 fractures of the mandible. Nine outcome variables were analysed with a further 19 included to adjust for potential confounding. Treatment delay was found not to significantly alter the incidence of infection dehiscence, non-union, harder exposure, nerve damage, return to theatre, trismus, malocclusion or radiographic outcome. They did find patients with an American Society of Anesthesiologists (ASA) of three or more were more likely to return to theatre and that longer surgery was more likely to result in wound dehiscence wound nerve damage and malocclusion. Patients with three fractures or more were more likely to develop trismus, and comminuted fractures were 11.8 fold more likely to have a poor radiographic outcome. The authors conclude that mandibular fractures should be undertaken in a semi-urgent manner where feasible, although the influence of unmeasured outcomes such as patient comfort, pain, nutritional compromise or to minimise admission length, may influence the urgency of treatment.
When to treat a fractured mandible?
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