Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1603460
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Multi-institutional Analysis of Surgical Management and Outcomes of Mandibular Fracture Repair in Adults

Dmitry Zavlin1, Kevin T. Jubbal2, Anthony Echo1, Shayan A. Izaddoost3, 4, Jeffrey D. Friedman1, Olushola Olorunnipa3, 4
  • 1Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
  • 2Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California
  • 3Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
  • 4Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
Further Information

Publication History

01 February 2017

25 February 2017

Publication Date:
08 June 2017 (eFirst)


Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic characteristics, surgical treatment, and clinical outcomes of surgical repair of mandible fractures in the United States. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult databases of the years 2006 through 2014 was performed identifying 940 patients with an International Classification of Diseases, version 9 (ICD-9) diagnosis of either closed or open fracture of the mandible. Preoperative, perioperative, and postoperative details were categorized and evaluated for these two cohorts. Multivariate analysis was performed to detect risk factors related to any complications. Patients were predominantly male (85.7%), young with a mean age of 34.0 ± 14.8 years, and relatively healthy with body mass index of 23.6 ± 8.2 and an American Society of Anesthesiologists (ASA) class of 1 or 2 (84.4%). However, more than half were regular smokers (51.1%). The top five most frequent procedures performed for mandibular repair were exclusively open surgical approaches with internal, external, or interdental fixation in both cohorts. Patients with open fractures were more often admitted as emergencies, treated inpatient, required longer operative times, and presented with more contaminated wounds (p < 0.05). Overall, medical (1.7%) and surgical complications (3.7%) were low. A high ASA class 3 or above and emergency operations were identified as risk factors for medical adverse events. Despite frequent concomitant injuries after trauma and a diverse array of mandibular injury types, our patient sample demonstrated favorable outcomes and low complication rates. Open surgical techniques were the most common procedures in this study representing the American population.

Ethical Considerations

The work described in this article was approved by our institutional review board (Protocol number Pro00011704: “Observational Research in the Department of Plastic and Reconstructive Surgery”). The authors adhered to the Declaration of Helsinki at all times.