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Updated: May 23, 2026
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Predictors of New-Onset Anxiety or Depression Following Open Reduction and Internal Fixation of Mandible Fractures
Andrew Salib1, Victoria Kong1, William Bai2
1Research Fellow, Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Background:
Maxillofacial trauma may result in psychosocial morbidity.
Purpose:
To estimate the risk of and identify factors associated with newly detected depression or anxiety diagnoses following open reduction and internal fixation (ORIF) of isolated mandible fractures.
Study Design, Setting, And Sample:
This retrospective cohort study included adults with isolated mandible fractures, regardless of open or closed status, treated with ORIF from 2010 to 2023 using a large national insurance claims database. Patients with prior depression or anxiety, concomitant injuries, age <18 years, or <90 days of follow-up were excluded.
Predictors:
The predictor variable was a set of heterogenous factors including (1) Structural healing complications, defined by the International Classification of Diseases, Ninth and 10th Revision (ICD-9/10) codes for nonunion or malunion within 90 days postoperatively. (2) Functional impairment, defined by ICD-9/10 codes for temporomandibular joint ankylosis or malocclusion within 90 days. (3) Demographic factors, including Charlson Comorbidity Index, age, sex, insurance type, and substance use defined by ICD-9/10 coding prior to mandible fracture.
Main Outcome Variable:
New ICD-9/10 diagnosis of depression or anxiety within 6 months after ORIF.
Analyses:
Relative risks (RRs) were calculated for bivariate associations between predictors and 6-month depression or anxiety. A multivariable logistic regression model was used to identify the independent associations between predictors and 6-month depression or anxiety. Statistical significance was defined as P ≤ .006 after Bonferroni correction.
Results:
Among 13,919 subjects, 840 (6.0%) had new depression or anxiety diagnoses within 6 months postoperatively. Structural healing complications (10.9 vs 5.8%; RR 1.86, 95% CI 1.32 to 2.61) and functional impairment (11.2 vs 5.8%; RR 1.93, 95% CI 1.30 to 2.84) (both P < .001) were associated with higher rates of depression or anxiety diagnoses. On multivariable analysis, structural healing complications (odds ratio [OR] 1.69, 95% CI 1.12 to 2.44), functional impairment (OR 1.99, 95% CI 1.24 to 3.05), female sex (OR 1.69, 95% CI 1.45 to 1.97), Medicaid insurance (OR 1.36, 95% CI 1.15 to 1.61), higher Charlson Comorbidity Index (OR 1.11, 95% CI 1.07 to 1.15), and substance use (OR 1.86, 95% CI 1.48 to 2.32) independently predicted depression or anxiety diagnoses (all P ≤ .006).
Conclusion:
Patients with complications, female sex, substance use, or socioeconomic disadvantage may benefit from postoperative psychiatric screening.
