Related Experiment Video
Updated: Aug 20, 2026
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Risk factors associated with complications in surgical treatment of mandibular fractures: a retrospective study
Christine T J W Lwin1, Riya Suleiman2, Sajeev Nair3
1Consultant in Oral and Maxillofacial Surgery, University Hospitals Dorset NHS Foundation Trust, Department of Oral & Maxillofacial Surgery, Longfleet Road, Poole, Dorset BH15 2JB, UK.
Abstract:
The aim of this study was to identify risk factors associated with complications following mandibular fracture open reduction and internal fixation (MORIF). The secondary purpose was to determine if a delay in surgery contributed to complications. Analysed complications were: surgical site infection (SSI), plate removal (PR), non-union (NU), repeat open reduction and internal fixation (re-ORIF), occlusal discrepancy (OD), second operation, postoperative paraesthesia (POP) and temporomandibular joint (TMJ) symptoms. Factors analysed for association were: patient factors (sex, age, smoking, alcohol, immunocompromise, recreational drug use), surgeon factors (grade), fracture factors, single vs multiple, number of fracture sites, side, displacement, horizontal favourability for angle and site of fracture, symphysis, parasymphysis (PS), body, angle and condyle ± presence of vertical shortening (VS). A retrospective cohort study of 252 patients treated, in a single centre between October 2015 and November 2023. All patients underwent MORIF ± condyle fracture open reduction and internal fixation (CORIF) ± maxillomandibular fixation (MMF). Risk factors associated with complications were: CORIF and SSI (OR (95% CI) 7.92 (1.62-77.48) p = 0.009), age and SSI (OR (95% CI) 1.03 (1.00-1.06) p = 0.029) age and OD (OR (95% CI) 1.03 (1.01-1.05) p = 0.010), condyle fracture and OD (OR (95% CI) 2.32 (1.20-4.53) p = 0.012), immunosuppression and PR (OR (95% CI) 16.41 (2.83-113.2) p = 0.003), vs condyle fracture and PR (OR (95% CI) 0.17 (0.02-0.94) p = 0.041), age and NU (OR (95% CI) 1.06 (1.02-1.10) p = 0.008), CORIF and NU (OR (95% CI): 11.25 (1.16-1491.4) p = 0.035) and immunosuppression and second operation (OR (95% CI) 5.64 (1.03-35.6) p = 0.046). There was no significant association between delay in time of surgery with any of the complications analysed, suggesting that selected mandibular fractures may be suitable for semi-elective management.
Insights
This study identified risk factors for complications after mandibular fracture surgery, finding age and condyle fractures increase risks. Importantly, surgical delay did not significantly impact complication rates, suggesting semi-elective treatment is viable.
Area of Science:
- Oral and Maxillofacial Surgery
- Trauma Surgery
- Orthognathic Surgery
Background:
- Mandibular fractures require surgical intervention for optimal outcomes.
- Complications following open reduction and internal fixation (ORIF) can impact patient recovery.
- Identifying risk factors is crucial for improving surgical planning and patient management.
Purpose of the Study:
- To identify patient, fracture, and surgical factors associated with complications after mandibular fracture open reduction and internal fixation (MORIF).
- To determine if delayed surgical intervention increases the risk of postoperative complications.
- To analyze specific complications including surgical site infection (SSI), plate removal (PR), non-union (NU), and occlusal discrepancy (OD).
Main Methods:
- Retrospective cohort study of 252 patients undergoing MORIF between October 2015 and November 2023.
- Analysis of various risk factors including patient demographics, smoking, alcohol use, fracture characteristics, and surgical approach (e.g., condyle fracture ORIF).
- Statistical analysis to determine associations between risk factors and specific complications using odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- Condyle fracture open reduction and internal fixation (CORIF) was associated with increased risk of SSI (OR 7.92) and non-union (NU) (OR 11.25).
- Increasing age correlated with higher risks of SSI (OR 1.03), occlusal discrepancy (OD) (OR 1.03), and NU (OR 1.06).
- Immunocompromised patients had a significantly higher risk of plate removal (PR) (OR 16.41) and requiring a second operation (OR 5.64).
Conclusions:
- Age, condyle involvement in fixation, and immunocompromised status are significant risk factors for complications following MORIF.
- Surgical delay was not found to be a significant risk factor for any analyzed complications.
- These findings support the potential for semi-elective management in selected cases of mandibular fractures, optimizing treatment timing.
