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

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The Birmingham Mandible and Mid-face (BruMM) rules: interim data analysis.

Roc Elledge¹, S Vatharkar¹, D McNulty¹

¹University Hospitals Birmingham NHS Foundation Trust, UK.

Annals of the Royal College of Surgeons of England

|July 15, 2025

Summary

Developing clinical decision rules for facial fractures can improve diagnostic accuracy and reduce unnecessary imaging. Early results show malocclusion is a strong predictor of mandibular fractures, guiding future research.

Keywords:

Facial fracture Mandible Radiograph Zygoma

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Area of Science:

Medical imaging
Radiology
Clinical decision support

Background:

Clinical predictor rules enhance clinician confidence and decision-making.
Established rules, like the Ottawa Ankle Rules, reduce unnecessary radiography, radiation exposure, and costs.
Developing similar rules for facial fractures can improve diagnostic accuracy and patient care.

Purpose of the Study:

To identify and validate clinical predictor variables for mandibular and zygomatic fractures.
To develop evidence-based clinical decision rules for diagnosing facial fractures.

Main Methods:

A Delphi study identified potential predictor variables for facial fractures.
Clinicians prospectively collected data on suspected fractures using a proforma.
Interim analysis involved cross-tabulating predictors against radiographic outcomes using statistical tests (sensitivity, specificity, Jaccard index, odds ratio, Fisher's exact test).

Main Results:

An interim analysis of 69 records (20 fractures) identified significant predictors.
Malocclusion (p<0.0001, OR 31.99), new open bite (p<0.001), and subconjunctival hemorrhage (p<0.05) were associated with fractures.
Fisher's exact test yielded statistically significant results for these predictors.

Conclusions:

Data collection is ongoing, with an interim analysis suggesting a required sample size of 252 for a specificity of 0.90.
Finalized data and analysis are anticipated in 2025.
The study aims to establish reliable clinical decision rules for facial fracture diagnosis.