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Facial Plast Surg 2023; 39(03): 214-219
DOI: 10.1055/a-2008-2723
Original Article

Evidence-Based Medicine for Mandible Fracture Repair: Current Controversies and Future Opportunities

Thomas Barrett 
1   Department of Otolaryngology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
,
John Chi
1   Department of Otolaryngology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
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Abstract

Mandibular fractures are among the most common facial fractures resulting from trauma. The nature of the injury, involved facial structures, presence of associated injuries, the dental status of the patient, comorbid conditions, and psychosocial context all must be considered by the surgeon when planning the optimal treatment for these patients. While consensus exists for many aspects of the management of mandibular trauma, some elements remain controversial. Three such topics—antibiotic therapy, treatment of subcondylar fractures, and management of the third molar—remain particularly controversial, with significant heterogeneity in practice patterns and without widely accepted evidence-based guidelines to standardize care. The goals of this work are to (1) review the historical perspective underlying these controversies, (2) summarize recent evidence shaping the current debate, and (3) highlight opportunities for continued efforts to identify best practices.

Keywords

facial trauma - mandible fractures - antibiotics


Publication History

Accepted Manuscript online:
05 January 2023

Article published online:
22 February 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Afrooz PN, Bykowski MR, James IB, Daniali LN, Clavijo-Alvarez JA. The epidemiology of mandibular fractures in the United States, part 1: a review of 13,142 cases from the US National Trauma Data Bank. J Oral Maxillofac Surg 2015; 73 (12) 2361-2366
    CrossrefPubMedGoogle Scholar
  • 2 Morrow BT, Samson TD, Schubert W, Mackay DR. Evidence-based medicine: mandible fractures. Plast Reconstr Surg 2014; 134 (06) 1381-1390
    CrossrefPubMedGoogle Scholar
  • 3 Hollier L. Larry H Hollier, Jr., M.D. Seminars in Plastic Surgery 2010; 24: 335-336
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Shridharani SM, Berli J, Manson PN, Tufaro AP, Rodriguez ED. The role of postoperative antibiotics in mandible fractures: a systematic review of the literature. Ann Plast Surg 2015; 75 (03) 353-357
    CrossrefPubMedGoogle Scholar
  • 5 Zallen RD, Curry JT. A study of antibiotic usage in compound mandibular fractures. J Oral Surg 1975; 33 (06) 431-434
    PubMedGoogle Scholar
  • 6 Miles BA, Potter JK, Ellis III E. The efficacy of postoperative antibiotic regimens in the open treatment of mandibular fractures: a prospective randomized trial. J Oral Maxillofac Surg 2006; 64 (04) 576-582
    CrossrefPubMedGoogle Scholar
  • 7 Gerlach KL, Pape HD. Studies on preventive antibiotics in the surgical treatment of mandibular fractures [in German]. Dtsch Z Mund Kiefer Gesichtschir 1988; 12 (06) 497-500
    PubMedGoogle Scholar
  • 8 Barker DA, Oo KK, Allak A, Park SS. Timing for repair of mandible fractures. Laryngoscope 2011; 121 (06) 1160-1163
    CrossrefPubMedGoogle Scholar
  • 9 Wick EH, Deutsch B, Kallogjeri D, Chi JJ, Branham GH. Effectiveness of prophylactic preoperative antibiotics in mandible fracture repair: a national database study. Otolaryngol Head Neck Surg 2021; 165 (06) 798-808
    CrossrefPubMedGoogle Scholar
  • 10 Dawoud BES, Kent S, Henry A. et al; MTReC. Use of antibiotics in traumatic mandibular fractures: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 59 (10) 1140-1147
    CrossrefPubMedGoogle Scholar
  • 11 Abubaker AO, Rollert MK. Postoperative antibiotic prophylaxis in mandibular fractures: a preliminary randomized, double-blind, and placebo-controlled clinical study. J Oral Maxillofac Surg 2001; 59 (12) 1415-1419
    CrossrefPubMedGoogle Scholar
  • 12 Oppelaar MC, Zijtveld C, Kuipers S. et al. Evaluation of prolonged vs short courses of antibiotic prophylaxis following ear, nose, throat, and oral and maxillofacial surgery: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg 2019; 145 (07) 610-616
    CrossrefPubMedGoogle Scholar
  • 13 Stone IE, Dodson TB, Bays RA. Risk factors for infection following operative treatment of mandibular fractures: a multivariate analysis. Plast Reconstr Surg 1993; 91 (01) 64-68
    CrossrefPubMedGoogle Scholar
  • 14 Andreasen JO, Storgård Jensen S, Kofod T, Schwartz O, Hillerup S. Open or closed repositioning of mandibular fractures: is there a difference in healing outcome? A systematic review. Dent Traumatol 2008; 24 (01) 17-21
    CrossrefPubMedGoogle Scholar
  • 15 Odom EB, Snyder-Warwick AK. Mandible fracture complications and infection: the influence of demographics and modifiable factors. Plast Reconstr Surg 2016; 138 (02) 282e-289e
    CrossrefPubMedGoogle Scholar
  • 16 Domingo F, Dale E, Gao C. et al. A single-center retrospective review of postoperative infectious complications in the surgical management of mandibular fractures: postoperative antibiotics add no benefit. J Trauma Acute Care Surg 2016; 81 (06) 1109-1114
    CrossrefPubMedGoogle Scholar
  • 17 Choi K-Y, Yang J-D, Chung H-Y, Cho B-C. Current concepts in the mandibular condyle fracture management part I: overview of condylar fracture. Arch Plast Surg 2012; 39 (04) 291-300
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 1983; 41 (02) 89-98
    CrossrefPubMedGoogle Scholar
  • 19 Strohl AM, Kellman RM. Current management of subcondylar fractures of the mandible, including endoscopic repair. Facial Plast Surg Clin North Am 2017; 25 (04) 577-580
    CrossrefPubMedGoogle Scholar
  • 20 van den Bergh B, Blankestijn J, van der Ploeg T, Tuinzing DB, Forouzanfar T. Conservative treatment of a mandibular condyle fracture: comparing intermaxillary fixation with screws or arch bar. A randomised clinical trial. J Craniomaxillofac Surg 2015; 43 (05) 671-676
    CrossrefPubMedGoogle Scholar
  • 21 He D, Cai Y, Yang C. Analysis of temporomandibular joint ankylosis caused by condylar fracture in adults. J Oral Maxillofac Surg 2014; 72 (04) 763.e1-763.e9
    CrossrefPubMedGoogle Scholar
  • 22 Eckelt U, Schneider M, Erasmus F. et al. Open versus closed treatment of fractures of the mandibular condylar process-a prospective randomized multi-centre study. J Craniomaxillofac Surg 2006; 34 (05) 306-314
    CrossrefPubMedGoogle Scholar
  • 23 Kokemueller H, Konstantinovic VS, Barth EL. et al. Endoscope-assisted transoral reduction and internal fixation versus closed treatment of mandibular condylar process fractures–a prospective double-center study. J Oral Maxillofac Surg 2012; 70 (02) 384-395
    CrossrefPubMedGoogle Scholar
  • 24 Al-Moraissi EA, Ellis III E. Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: a systematic review and meta-analysis. J Oral Maxillofac Surg 2015; 73 (03) 482-493
    CrossrefPubMedGoogle Scholar
  • 25 Shi D, Patil PM, Gupta R. Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures. J Craniomaxillofac Surg 2015; 43 (03) 402-407
    CrossrefPubMedGoogle Scholar
  • 26 Nasser M, Fedorowicz Z, Ebadifar A. Management of the fractured edentulous atrophic mandible. In: Cochrane Database of Systematic Reviews, ed. The Cochrane Collaboration, CD006087. Hoboken, NJ: John Wiley & Sons, Ltd; 2007
    CrossrefGoogle Scholar
  • 27 Tevepaugh DB, Dodson TB. Are mandibular third molars a risk factor for angle fractures? A retrospective cohort study. J Oral Maxillofac Surg 1995; 53 (06) 646-649 , discussion 649–650
    CrossrefPubMedGoogle Scholar
  • 28 Ruela WS, de Almeida VL, Lima-Rivera LM. et al. Does an association exist between the presence of lower third molar and mandibular angle fractures?: a meta-analysis. J Oral Maxillofac Surg 2018; 76 (01) 34-45
    CrossrefPubMedGoogle Scholar
  • 29 Brucoli M, Boffano P, Pezzana A. et al. The “European Mandibular Angle” Research Project: the epidemiologic results from a multicenter European collaboration. J Oral Maxillofac Surg 2019; 77 (04) 791.e1-791.e7
    CrossrefPubMedGoogle Scholar
  • 30 Bobrowski AN, Sonego CL, Chagas Junior OL. Postoperative infection associated with mandibular angle fracture treatment in the presence of teeth on the fracture line: a systematic review and meta-analysis. Int J Oral Maxillofac Implants 2013; 42 (09) 1041-1048
    CrossrefPubMedGoogle Scholar
  • 31 de Amaratunga NA. The effect of teeth in the line of mandibular fractures on healing. J Oral Maxillofac Surg 1987; 45 (04) 312-314
    CrossrefPubMedGoogle Scholar
  • 32 McNamara Z, Findlay G, O'Rourke P, Batstone M. Removal versus retention of asymptomatic third molars in mandibular angle fractures: a randomized controlled trial. Int J Oral Maxillofac Implants 2016; 45 (05) 571-574
    CrossrefPubMedGoogle Scholar
  • 33 Ulbrich N, Ettl T, Waiss W. et al. The influence of third molars in the line of mandibular angle fractures on wound and bone healing. Clin Oral Investig 2016; 20 (06) 1297-1302
    CrossrefPubMedGoogle Scholar
  • 34 Lim H-Y, Jung T-Y, Park S-J. Evaluation of postoperative complications according to treatment of third molars in mandibular angle fracture. J Korean Assoc Oral Maxillofac Surg 2017; 43 (01) 37-41
    CrossrefPubMedGoogle Scholar
  • 35 Radabaugh JP, Horn AV, Chan SA, Shelton JM, Gal TJ. Patient compliance following isolated mandibular fracture repair. Laryngoscope 2017; 127 (10) 2230-2235
    CrossrefPubMedGoogle Scholar
  • 36 Bagheri SC, Dimassi M, Shahriari A, Khan HA, Jo C, Steed MB. Facial trauma coverage among level-1 trauma centers of the United States. J Oral Maxillofac Surg 2008; 66 (05) 963-967
    CrossrefPubMedGoogle Scholar
  • 37 Sun A, Nguyen K, Mehta SK, Allam O, Park KE, Alperovich M. Does surgical specialty impact mandibular fracture outcomes?. J Craniofac Surg 2021; 32 (03) 855-858
    CrossrefPubMedGoogle Scholar