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Postoperative maxillomandibular fixation after open reduction of mandible fractures
Masoud Saman1, Sameep Kadakia2, Yadranko Ducic1
1Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.
Importance:
Patients are placed in maxillomandibular fixation (MMF) to restore premorbid occlusion prior to open reduction-internal fixation (ORIF) of mandibular fractures. Maintaining MMF for these patients for several weeks postoperatively is a widely accepted dictum.
Objective:
We compare postoperative ORIF outcomes in dentate patients with noncomminuted symphyseal, parasymphyseal, or angle fractures of the mandible between those who underwent postoperative MMF and those who did not.
Design, Setting, And Participants:
Retrospective review of medical records for 311 patients with 413 mandibular fractures treated at a level 1 public trauma center in the Fort Worth, Texas, metropolitan area. All patients were treated from August 1997 to August 2012 and had a minimum follow-up of 6 weeks.
Interventions:
Of the 413 symphyseal, parasymphyseal, and angle fractures, 78, 63, and 83 patients were treated with postoperative MMF respectively. The group without postoperative MMF included 56 symphyseal fractures, 49 parasymphyseal fractures, and 84 angle fractures.
Main Outcomes And Measures:
Rates of wound dehiscence, infection, plate removal, nonunion, malunion, and malocclusion were compared.
Results:
Using an unpaired t test and α value of .05 for significance, the difference between the 2 groups' outcomes was not statistically significant for any of the complications evaluated. In the groups with vs without postoperative MMF, the mean numbers of complications were as follows: wound dehiscence, 4.7 vs 2.5 (95% CI, -1.7 to 6.0) (P = .16); infection, 6.7 vs 4.0 (95% CI, -1.7 to 7.0) (P = .14); plate removal, 2.3 vs 2.5 (95% CI, -7.9 to 7.6) (P = .94); nonunion, 1.0 vs 0.5 (95% CI, -2.2 to 3.2) (P = .59); malunion, 0.7 vs 1.0 (95% CI, -3.1 to 2.4) (P = .72); and malocclusion, 1.3 vs 1.0 (95% CI, -4.0 to 4.7) (P = .82).
Conclusions And Relevance:
The surgical dictum of maintaining postoperative MMF for all trauma patients after ORIF of the mandible may not be of advantage in the treatment of dentate patients with noncomminuted symphyseal, parasymphyseal, or angle fractures.
