Type of publication:
*Mustafa E.; Hanu-Cernat L.
British Journal of Oral and Maxillofacial Surgery; Dec 2015; vol. 53 (no. 10)
Introduction: Revision rates following open reduction-fixation of mandibular fractures are not widely reported. This study aims to identify fracture and occlusal patterns asso-ciated with operative difficulties and suboptimal outcomes requiring further surgical correction. Method: All patients who required revision reduction and fixation of mandible fractures at the University Hospital Coventry between November 2008 and December 2013 were identified from the theatre database. Patients treated beyond five weeks, requiring plate removal secondary to infection or those that underwent staged fixation of complex facial trauma were excluded. Radiographs, theatre entries and patient records were examinedtoidentify patient demographics, fracture patterns, operative technique and the grade of the operating surgeon. Results: The return to theatre rate in our series was 2.3% (12 cases out of 524). The need for re-intervention was primarily established on clinical grounds. Revisions were required in: 1. Patients non-compliant with diet modification advice. 2. Pre-existent class III malocclusion. 3. Condylar fractures failing conservative management. 4. Wisdom teeth or a dominant occluding molar left in the line of the fracture. 5. Dentoalveolar injury. 6. Inadequate reduction/fixation on first intervention. No correlation was noted with the timing of treatment or occlusal control. Conclusion: Cases that needed revision surgery were fairly stereotype in our series. Poor outcomes were associated with significant occlusal interferences (pre-existing malocclusions, dentoalveolar fractures or teeth retainedinthe line of fracture) and unstable fracture patterns. Awareness of these risk factors may help with the anticipation of operative difficulties and lead to improved treatment outcomes.