Is Fixation of Mandible Fractures Urgent?

Background

Mandible fractures have been studied extensively, but controversy remains over the urgency of repair. There are conflicting reports on this topic with some recommending immediate fixation, or at least within the first 72 hours, whereas others claim that repairs as late as five days post-injury do just as well. There are a number of considerations that influence timing of intervention, such as associated injuries, which can preclude aggressive surgical manipulation. However, there is a transition period when the sense of “urgency” becomes more germane.

Should a closed reduction with mandibular-maxillary fixation (MMF) be promptly performed at the beside of the intensive care unit patient? Alternatively, can they be conveniently seen in the office and scheduled for elective surgery within a week or two? Intuitively, delayed repair can be associated with compromised nutrition, poor hygiene, inflammation, scarring within the fracture, and even contamination. On the other hand, facial swelling can also subside and facilitate exposure. Most importantly, however, is whether or not the final outcomes are impacted in terms of union and occlusion.

Best Practice

Delay in repair can be associated with technical challenges and complications. A more vigilant debridement, reduction, and fixation are all warranted. Delay up to five days after injury has not been shown to compromise outcomes in terms of bony union and occlusion. Substance abuse appears to be associated with a greater rate of infection. Read the full article in The Laryngoscope.