Are open mandibular fractures still an emergency?

Area of Science:

• Oral and Maxillofacial Surgery
• Trauma Surgery

Background:

• Surgical management is often recommended for mandibular fractures.
• A 6-hour window for surgical fixation has been a long-standing guideline.
• This study questions the necessity of this strict timeframe.

Purpose of the Study:

• To evaluate the impact of surgical delay on complication rates in mandibular fractures.
• To challenge the conventional 6-hour surgical fixation paradigm.

Main Methods:

• Retrospective analysis of 47 patients with tooth-bearing mandibular fractures (September 2012 - May 2014).
• Data collected included patient demographics, fracture etiology, comorbidities, and preoperative delay.
• Complications such as hematoma, infection, and osteosynthesis failure were recorded.

Main Results:

• 76.6% of patients had surgical delays exceeding 6 hours, often due to unavoidable reasons.
• The mean delay was 52 hours; 49% of patients had comorbidities.
• Overall complication rate was 16.67%, with a higher rate in smokers (P=0.006). No significant relationship was found between delay and complications (P=0.994).

Conclusions:

• Fractures of the tooth-bearing mandible may not require urgent surgical intervention within 6 hours.
• Surgical delay does not appear to correlate with increased complication rates.
• This challenges the established emergency management protocol for these fractures.