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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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Delayed Low Energy Mandible Fracture Repair: Retrospective Review of 195 patients
Salvatore Lettieri, MD1, David Yao, MD2, David Shafer, MD2, Molly Walsh, DO2.
1Mayo Clinic, Phoenix, AZ, USA, 2Mayo Clinic, Rochester, MN, USA.

Purpose: There is often a delay in patients presenting for mandible fracture repair. There is ample evidence to recommend immediate repair, but little with regard to delayed repair. This is a retrospective study to review the delayed repair of low energy mandible fractures including outcome analysis.
Methods: This is a retrospective review of 195 patients with 306 mandible fractures collected at a single trauma center. The time period was from 2000 to 2005. The population base includes outside ER referrals as clinic visits, self referrals, and inpatients that are critically ill. Patients were all more than 72 hours from injury. All patients with high energy injuries such as gunshot wounds, severe comminution from blunt trauma and patients with old injuries (more than one month old) were excluded. Charts were reviewed extracting information regarding timing of operative repair, time to release from MMF, complication rates, and patient co-morbid risk factors. The co-morbid risk factors include smoking, substance abuse, diabetes, steroid use, and immunosuppression. Data was collected and compared to historical data.
Results: Analysis of time to repair and time to release from MMF showed no significantly increased complication rate in the perioperative period. 195 patients were evaluated. Males constituted 86.1% and females 13.9% of the patients. 36.9% were self identified smokers. 57.4% and 33.6% had 2 and 1 radiographically identified mandible fractures, respectively. Average length of time to repair was approximately 15.7 days. Complication rates were: infection 8.2%, malocclusion 4.9%, non union 1.6%, and plate exposure 0.8%. No significant correlation could be made between at least one co-morbid risk factor and complications.
Conclusion: Delayed mandible fracture repair does not significantly lead to increased complication rates in the perioperative period. It is still recommended to repair mandibles as soon as feasible but if there are delays in presentation and scheduling such as in non-compliant patients, delayed referral, and critically ill patients, this evidence supports the decision to electively repair the mandible. This study does not reflect any evidence regarding high energy type mandible fractures.

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