11.0: Thursday, March 17, 2005

Trauma Algorithms: should intracranial imaging be routine in patients with mandible fractures?

Wendy L. Parker, MD, M. Czerwinski, MD, and H. Bruce Williams, MD.

Purpose: Mandibular trauma can potentially increase our predictive accuracy for intracranial (IC) and cervical-spine injuries. Our goals: 1. investigate the association of mandible fractures with minor head injury (MHI), severe intracranial injury (SICI), and cervical-spine injury; 2. determine predictors of the IC pathology in a Level 1 Canadian trauma center.

Methods: A retrospective review was performed of mandible fractures treated at the MGH from 1997-2003. Patients with CT brain and cervical spine were considered eligible. Data included patient, fracture, and mechanism characteristics, neurological status and concomitant injuries.

Results: Of 181 patients, 86 with representative demographics were eligible. The incidence of MHI was 37%, SICI 27%, and cervical-spine injury 6.7%. MOI for MHI /SICI were assault (34/ 13%), MVC (44/52%), and fall (19/30%) respectively. Significant risk factors for MHI/ SICI were multiple sites of mandible fracture (44/16%), comminution (27/27%), and associated facial fractures (27/36%) respectively. 68% of patients with GCS <12 had SICI.

Conclusions: It has been advocated to treat mandible fractures on a focused outpatient basis. Our results of significant concomitant IC injury, however, suggest that this may result in the oversight of potentially life threatening injuries. Thus, we recommend intracranial CT as routine, especially with risk factors.