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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible

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Published on: January 28, 2020

Algorithm for head computed tomography imaging in patients with mandible fractures.

Marcin Czerwinski¹, Wendy L Parker, H Bruce Williams

¹Division of Plastic Surgery, McGill University Health Sciences Center, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada. marcin.czerwinski@mail.mcgill.ca

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons

|October 14, 2008

Summary

Mandible fractures are associated with a high incidence of intracranial injuries (ICIs), including traumatic brain injury (TBI). Alcohol use, facial fractures, and systemic injuries predict ICIs in these patients.

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Area of Science:

Trauma surgery
Neurosurgery
Emergency medicine

Background:

Mandible fractures can be associated with intracranial injuries due to anatomical proximity.
Predictive accuracy for intracranial injuries (ICIs) may be enhanced by analyzing mandible fractures.

Purpose of the Study:

Investigate the association between mandible fractures and traumatic brain injury (TBI) and intracranial lesions (ICLs).
Identify predictors of ICIs in patients with mandible fractures.

Main Methods:

Retrospective chart review of 181 patients with mandible fractures treated between 1997 and 2003.
Included patients had postinjury head CT scans and at least 4 weeks of follow-up.
Collected data on patient and fracture characteristics, neurological evaluation, and concomitant injuries.

Main Results:

86 eligible patients were analyzed, representative of an urban trauma population.
Incidence of TBI was 68.6% and ICLs was 27%.
Alcohol use (OR, 3.97), concomitant facial fracture (OR, 2.77), and other systemic injury (OR, 2.59) independently predicted ICIs.

Conclusions:

Mandible fractures are associated with significant rates of concomitant ICIs.
Outpatient management of mandible fractures may lead to missed life-threatening injuries.
Recommend mandatory intracranial CT imaging for patients with unknown neurologic status, TBI criteria, or positive ICI predictors.