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Published on: January 28, 2020
Intraoral Wound Dehiscence After Open Reduction Internal Fixation of Mandibular Fractures: A Retrospective Cohort
Shadia Abdelhameed Elsayed1, Abdel Aziz Baiomy Abdullah2, Najla Dar-Odeh3
1Al Azhar University, Cairo, Egypt; Taibah University Dental College and Hospital, Al-Madinah Al-Munawwrah, Saudi Arabia.
Introduction:
The high prevalence of intraoral wound dehiscence (IOWD) following open reduction internal fixation of mandibular fractures has not been well studied.
Objective:
A retrospective cohort study was conducted to investigate and assess possible risk factors for IOWD related to patients and surgical technique.
Methods:
All patients who did not have diabetes, were not medically compromised such as patients with nutritional deficiencies or endocrine disorders, did not smoke, did not consume alcohol, and had mandibular fractures managed through open reduction internal fixation and via intraoral vestibular incision from January 2007 to December 2019, at Al-Azhar University Hospitals, in Cairo, Egypt were included in the study. Study data were collected and grouped according to the demographic characteristics of patient age and sex and fracture-related factors of cause, side, site, displacement severity, fixation device, infection, and history of dehiscence. Follow-up of all patients was conducted daily during the first week and weekly during the first month after surgery. Data were analyzed using cross-tabulation with Pearson chi-squared test to calculate the significance of associations between various independent variables and occurrence of IOWD; P less than or equal to .05 was viewed as statistically significant.
Results:
The study included 69 mandibular fracture patients (age range, 13-55 years [mean, 28.13 ± 11.5 years]) treated using different osteosynthesis fixation devices, including miniplates, lag screws, and heavy locking plates. No statistically significant differences were noted between groups in terms of age, sex, and surgical attributes of fracture site, displacement severity, or fixation type with regard to IOWD (P > .05). None of the included patients were medically compromised, smoked, or used alcohol. Intraoral wound dehiscence occurred in 7 patients (10.1%) and was managed conservatively through copious irrigation with warm saline and chlorhexidine mouthwash in intermittent cycles of 5 times a day for 2 weeks; when infection was present, antibiotic prescription and drainage were provided. Complete wound closure was achieved after a maximum period of 2 weeks.
Conclusions:
A small proportion of mandibular fracture patients are expected to have IOWD complication even if a meticulous and appropriate surgical technique is implemented. Intraoral wound dehiscence has a good prognosis and it may require a maximum of 2 weeks to obtain healing with secondary epithelization of the bared bony sites.
