A treatment protocol for mandible fractures

Mandibular fracture management has evolved over several decades, and controversies exist over ideal approaches for individual fractures. Treatment choices include closed versus open techniques, reduction methods and repair, and decision concerning intermaxillary fixation. Both the patient and the fracture characteristics have an impact on these choices. Patient factors include age, mandibular bone quality, dentition, patient reliability, and associated injuries. Fracture characteristics include favorability versus unfavorability, single versus multiple, location, and infection. This study was undertaken to develop and evaluate a management algorithm to determine the best treatment of mandible fractures. Sixty-seven patients were managed at the Grady Memorial Hospital otolaryngology service. Ages ranged from 3 to 68 years and included 55 male patients and 12 female patients. Forty-three patients had multiple fractures, while 24 had single fractures. Sixty-four patients were successfully managed and had normal function on follow-up examination. Eleven patients (16.4%) had complications. These included three infections, one malunion, two malocclusions, and five marginal nerve pareses. Multiple fractures did not have a higher incidence of complication. This protocol allows an orderly approach to the successful outcome of mandibular fractures.