Infection Rates of an Intraoral Versus Extraoral Approach to Mandibular Fracture Repairs are Equal: A Systematic...

Area of Science:

• Oral and Maxillofacial Surgery
• Trauma Surgery
• Infectious Disease Epidemiology

Background:

• Mandibular fractures are common injuries requiring surgical intervention.
• Open reduction and internal fixation (ORFI) is a standard treatment for mandibular fractures.
• The choice between intraoral and extraoral surgical approaches for ORFI carries potential risks, including infection.

Purpose of the Study:

• To compare postoperative infection rates between intraoral and extraoral approaches for mandibular ORFI.
• To address a public health concern regarding infection risks in treating mandibular fractures.
• To inform clinical practice and potentially reduce healthcare costs associated with mandibular fracture treatment.

Main Methods:

• A systematic review and meta-analysis were conducted following PRISMA guidelines.
• Literature search of Embase and PubMed (1989-2023) identified comparative studies on intraoral vs. extraoral ORFI for mandibular fractures.
• Primary outcome was postoperative infection rate; random-effects models were used for data analysis due to heterogeneity.

Main Results:

• Eleven studies comparing 1,317 patients (937 intraoral, 380 extraoral) were included.
• Infection rates were 5.9% for intraoral and 10% for extraoral approaches.
• Pooled relative risk showed no significant difference (0.94 [95% CI, 0.63, 1.39]), despite heterogeneity in prevalence estimates.

Conclusions:

• No significant difference in infection rates was observed between intraoral and extraoral approaches for mandibular ORFI.
• Further research expanding on complication rates for different mandibular fixation approaches is warranted.
• Surgeon preference may currently dictate the choice of surgical approach in the absence of definitive evidence favoring one over the other.