Simple dentate area fractures of the mandible - can we prevent postoperative infections?

Surgical treatment of clinically infected mandibular fractures

PURPOSE

To clarify reasons for infections, surgical techniques, and occurrence of postoperative surgical site complications in infected mandibular fractures.

METHODS

Patients with clinically infected mandibular fracture of the dentate part without preceding surgery were studied retrospectively. Clinical infection was defined to occur if pus, abscess, or a fistula in the fracture area was present. Patient-, fracture-, and surgery-related variables were evaluated, and predictors for postoperative complications were analysed.

RESULTS

Of 908 patients with surgically treated fracture in the dentate part of the mandible, 41 had infected fracture at the time of surgery (4.5%). Of these patients, 46.3% were alcohol or drug abusers. Median delay from injury to surgery was 9 days. Patient-related factors were the most common cause for delayed surgery (n = 30, 73.2%), followed by missed diagnosis by a health care professional (n = 8, 19.5%). Twenty-two fractures were treated via extraoral approach (53.7%) and the remaining 19 intraorally (46.3%). Postoperative surgical site complications were found in 13 patients (31.7%), with recurrent surgical site infections predominating. Notable differences between total complication rates between intraoral and extraoral approaches were not detected. Secondary osteosynthesis for non-union was conducted for one patient treated intraorally.

CONCLUSIONS

Postoperative surgical site complications are common after treatment of infected mandibular fractures, and these occur despite the chosen surgical approach. Infected mandibular fractures heal mainly without bone grafting, and non-union is a rare complication. Due to the high complication rate, careful perioperative and postoperative care is required for these patients.

Postoperative wound dehiscence in mandibular fractures

OBJECTIVE

To clarify the occurrence and causes of non-infection-related surgical wound dehiscence (SWD) in intraorally treated mandibular fractures.

MATERIAL AND METHODS

Patients with one or two fractures of the dentate part of the mandible treated surgically via an intraoral approach were included in this retrospective study. The primary outcome variable was SWD. Associations between patient-, fracture- and surgery-related variables and SWD were evaluated.

RESULTS

Altogether 232 patients with 270 mandibular angle, body, symphysis and/or parasymphysis fractures were included in the analysis. In all, 22 SWDs were detected. These occurred in 9.5% of patients and in 8.1% of fractures. Surgery performed at night-time showed a significantly higher SWD rate than daytime surgeries (p = .012). Additionally, a significantly greater SWD rate was found among smokers (p = .041). Other studied variables remained statistically non-significant for SWD. In a multivariate analysis, night-time was the only significant independent variable with an odds ratio of 3.297 (95% CI 1.238 - 8.780, p = .017) for SWD.

CONCLUSION

The approach or closure technique used and the fracture type had only a minor effect on non-infection-related SWD in patients with mandibular fractures. To avoid SWDs, mandibular fracture surgeries should be conducted during the daytime with adequate support from an experienced surgeon.

Synthesis of Novel Antimicrobial CHX-CaCl2 Coatings on Maxillofacial Fixatures for Infection Prevention

Maxillofacial surgery placement of fixatures (Leonard Buttons, LB) at close proximity to surgical incisions provides a potential reservoir as a secondary local factor to advanced periodontal disease, with bacterial formation around failed fixatures implicating plaque. To address infection rates, we aimed to surface coat LB and Titanium (Ti) discs using a novel form of chlorhexidine (CHX), CHX-CaCl₂ and 0.2% CHX digluconate mouthwash as a comparison. CHX-CaCl₂ coated, double-coated and mouthwash coated LB and Ti discs were transferred to 1 mL artificial saliva (AS) at specified time points, and UV-Visible spectroscopy (254 nm) was used to measure CHX release. The zone of inhibition (ZOI) was measured using collected aliquots against bacterial strains. Specimens were characterized using Energy Dispersive X-ray Spectroscopy (EDS), X-ray Diffraction (XRD) and Scanning Electron Microscopy (SEM). SEM displayed copious dendritic crystals on LB/ Ti disc surfaces. Drug release from double-coated CHX-CaCl₂ was 14 days (Ti discs) and 6 days (LB) above MIC, compared to the comparison group (20 min). The ZOI for the CHX-CaCl₂ coated groups was significantly different within groups (p < 0.05). CHX-CaCl₂ surface crystallization is a new drug technology for controlled and sustained CHX release; its antibacterial effectiveness makes this drug an ideal adjunct following clinical and surgical procedures to maintain oral hygiene and prevent surgical site infections.

Maxillofacial Fractures: A Four-Year Retrospective Study of 1828 Cases in West China

OBJECTIVE

To analyze the epidemiological and clinical characteristics of maxillofacial fracture cases in a stomatological center in southwest China.

METHODS

This study includes 1828 cases of maxillofacial fractures treated in our hospital from January 2018 to December 2021. We analyzed the gender, age, causes of injury, fracture sites, concomitant injuries, treatment, and postoperative infection of these cases. Our data are also compared with those from similar domestic studies.

RESULTS

Among the 1828 cases, the male-to-female ratio was 2.48:1 with an average age of 34.55 ± 16.36 years. The highest incidence of fracture was 21-50 years old, and the most common cause of injury was falls (38.95%). There was a statistically significant difference in the composition of injury causes among different age groups(P<0.05). Mandible (37.56%) was the most easily fractured site, and limb injury (17.89%) was the most common concomitant body injury. In all cases, 85.23% of patients were treated with open reduction and internal fixation.  Conclusions: Maxillofacial fractures often occur in the mandible of young and middle-aged men. Falls and traffic accidents are the main causes of injury, often accompanied by limb and brain injuries. Open reduction and internal fixation is still the most commonly used treatment. There are some differences in the results reported by different domestic hospitals.