Purpose This is a retrospective analysis of functional outcome in patients with high velocity multisegmental mandibular fractures managed at R Adams Cowley Shock Trauma Center.
Methods Records of 99 consecutive patients treated from 1996 to 2000 with history of mandible fractures were retrieved from Shock Traumas Data Repository. Demographics, Injury and Severity Score (ISS), fracture characteristics, fracture management, and outcomes as related to temporal mandibular function and occlusal bite relationship was analyzed. Complications of infection, malunion, nonunion, hematoma, facial nerve weakness, and malocclusion were reviewed.
Results 63% of patients with high-velocity injuries had multisegmental fractures. 75% had associated facial injuries. Mean number of days to completed surgical management was 1.9 days. 84% were treated with ORIF. Mean follow-up was 6 months. At completion of treatment, 92% had maximum vertical opening (MVO) greater than 35mm. All patients with intracapsular fractures and/or subcondylar fractures had MVO greater than 35mm. 97% reached a stable balanced occlusal relationship. 22% of had complications with 81% of this group being related to infected teeth within the line of fracture.
Conclusions The functional demands of the mandible and its relationship to remaining craniofacial structures makes management of comminuted high velocity fractures an extreme challenge with high potential for complications and poor functional outcome. This retrospective analysis demonstrates successful outcomes when adherence to a functionally based protocol is followed. Early anatomic rigid fixation should be achieved. Severely diseased and/or fractured teeth within line of fracture should be extracted and all intraoral wounds closed. In high velocity injuries splinting with MMF during the inflammatory phase of wound healing avoids abnormal parafunctional activity and micro-motion at the fracture. A sequential phase of passive and then active physical therapy incorporating guiding orthodontic elastics is key for optimal harmonious dynamic function and occlusal relationship.