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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 12-14

A clinical assessment of postoperative complications of mandibular fractures using Mandibular Injury Severity Score at K. R. Hospital, Mysore


Department of Dentistry, K. R. Hospital, Mysore, Karnataka, India

Date of Web Publication26-Jun-2019

Correspondence Address:
Dr. T S Subash
Department of Dentistry, K. R. Hospital, Mysore 570 001, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_10_19

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  Abstract 

Introduction: Among the facial injury, the mandibular fractures represent a substantial portion of surgical case load to trauma centers. Management of this common injury varies greatly and is still driven by expert opinion or empirical data. Scientific study of mandible fractures and their treatment has been hampered by the lack of an injury cataloging system that allows a disciplined, systematic aggregation of collective clinical experiences. Materials and Methods: A prospective study was conducted in the Department of Dentistry, Mysore Medical College and Research Institute, Karnataka, Mysore, India. Subjects selected were above 16 years of age with isolated mandibular fractures who were eligible to undergo treatment. A total of 50 patients were divided into two groups, closed and open reduction, each having 25 subjects. Each individual case was evaluated for FLOSID components separately. Mandibular Injury Severity Score (MISS) was assigned based on summated results of FLOSID components. Obtained complication scores and MISS were correlated statistically using Spearman’s correlation coefficient among the different groups. Results: On comparison between the two groups, open reduction and internal fixation (ORIF) and maxillomandibular fixation (MMF), statistical analysis using Mann–Whitney U test showed mean and median values for the ORIF group as 6.52 and 5 (3–11), respectively whereas mean (SD) and median values in the MMF group as 5.52 (3.31) and 5 (3–3.5), respectively. There was proportional increase in both MISS and complication score. The aforementioned analysis indicates that MISS is a predictable parameter in assessing postoperative complications of mandibular fracture and also in predicting the complication outcomes in clinical situation. Conclusion: This study concludes that the higher the MISS, the higher the rate of complications in groups treated with ORIF. MISS however did not correlate much with groups treated using closed method. FLOSID taxonomy predicted the exact details of cases and helped arriving at MISSs, of individual cases with complication score to help the clinician to arrive and predict postoperative events, and to adopt proper treatment plan for individual cases, to minimize the complication score as low as possible, for the benefit patients with Maxillofacial trauma.

Keywords: FLOSID, mandibular fracture, Mandibular Injury Severity Score, ORIF, taxonomy


How to cite this article:
Sandeep Tejaswi S, Subash T S. A clinical assessment of postoperative complications of mandibular fractures using Mandibular Injury Severity Score at K. R. Hospital, Mysore. Int J Oral Care Res 2019;7:12-4

How to cite this URL:
Sandeep Tejaswi S, Subash T S. A clinical assessment of postoperative complications of mandibular fractures using Mandibular Injury Severity Score at K. R. Hospital, Mysore. Int J Oral Care Res [serial online] 2019 [cited 2019 Sep 21];7:12-4. Available from: http://www.ijocr.org/text.asp?2019/7/1/12/259919




  Introduction Top


Among the facial injury, the mandibular fractures represent a substantial portion of surgical case load to trauma centers. Management of this common injury varies greatly and is still driven by expert opinion or empirical data. Occurrence of postoperative complications continues to plague oral and maxillofacial surgeons regardless of technique used. Complications are of major or minor consequence but have the potential to develop into more significant, including debilitating pain, malunion, nonunion, chronic osteomyelitis, acquired skeletal deformities, extended hospital stay, and financial burden. Scientific study of mandible fractures and their treatment has been hampered by the lack of an injury cataloging system that allows a disciplined, systematic aggregation of collective clinical experiences.[1]

Purpose of the study

The purpose of this study were to evaluate anatomical and morphological characteristics of mandibular fractures in clinical presentation and to classify the type and location of fracture using FLOSID taxonomy, to evaluate the validity by relating to a variety of clinical complications and their outcomes, and to compare the Mandibular Injury Severity Score (MISS) to complication rates in different treatment methods for mandibular fractures.


  Materials and Methods Top


Source of data

A prospective study was conducted in the Department of Dentistry, Mysore Medical College and Research Institute, Mysore, Karnataka, India.

Method

The subjects aged older than 16 years with mean average age of the groups being 25.7 years were included in this study. Each individual case was evaluated for FLOSID components separately. MISS was assigned based on summated results of FLOSID components. Six injury attributes that were significant for directing care and influencing outcomes are denoted with an acronym as FLOSID: F (fracture type), L (location of fracture), O (occlusion), S (soft tissue damage), I (infection), D (interfragmentary displacement).

FLOSID taxonomy table



It is taken as mild (<2mm), moderate (2–4mm), and severe (>4mm).[5] Each case was evaluated for individual components of FLOSID, and the corresponding MISS was tabulated. Obtained complication scores and MISSs among different groups were correlated statistically using Spearman’s correlation coefficient.


  Results Top


A total of 50 patients were divided into two groups, one group treated with open method, that is, open reduction and internal fixation (ORIF) and the other group treated with closed method with maxillomandibular fixation (MMF). Each group had 25 subjects. For each case, treatment plan was based purely on surgeon’s decision. After the treatment, closed or open reduction of fractures in individual cases was evaluated clinically to assess the postoperative complications. Cases were examined immediately after treatment, after 1 week, and after 1 month. Each case was assigned to FLOSID components and accordingly MISS was assigned.[1],[2]

The MISS did not differ significantly among patients who received ORIF (median = 5) and those who were treated by closed reduction (median = 5) with P value = 0.6.

On comparison between the two groups, showed mean and median values in the ORIF group as 6.52 and 5 (3–11), respectively, whereas the MMF group showed mean (SD) and median as 5.52 (3.31) and 5 (3–3.5), respectively. The MISS did not differ significantly among patients who received ORIF (median = 5) and those who received MMF (median = 5) with a P value of 0.6. Of the patients, 64% treated with closed reduction and 24% treated with ORIF fell in complication score zone of 0, indicating that the group treated with closed methods had significantly less complication score than the group treated with ORIF. Of the patients, 28% treated with ORIF fell in the complication score zone of 3, indicating that maximum complications that all patients had were malunion or malocclusion clinically. On comparing mean MISS and complication scores among the groups treated with closed method and ORIF, it was observed that as the MISS increased, complication score increased proportionately: 6.52 (ORIF) to 5.52 (MMF) [Table 1]. Complication score was 2.36 in the ORIF group and 0.96 in the MMF group [Table 2]. There was proportional increase in both MISS and complication score. The aforementioned analysis indicates that MISS is a predictable parameter in assessing postoperative complications of mandibular fracture and also in predicting the complication outcomes in clinical situation [Figure 1].
Table 1: Comparison of MISSs among patients receiving ORIF and closed reduction

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,
Table 2: Comparison of complication scores among patients receiving ORIF and closed reduction

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,
Figure 1: Comparision of ORIF vs CLOSED REDUCTION

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  Discussion Top


Beyond communicating a reliable verbal image of the injury, such a system would serve as a basis for quantifying anatomic severity, help guide treatment, and predict and allow reporting or comparison of outcomes across patients and institutions.[3] The current climate of evidence-based clinical practice and extramural audit of quality of care and cost-effectiveness impose an urgency to develop more precise metrics for cataloging mandible fractures and establishing severity scoring to facilitate trauma care and research for better communication.[4],[5] This study showed that the complication rates remain higher with open reduction; however, MISS did not show much difference for groups treated with MMF, which is well coincided with other studies.[6] With improved plating systems and improved operator experience, closed reduction of mandibular fractures is the method with lowest incidence of postoperative complications of mandibular fractures. However, most complications were minor and resulted in eventual favorable outcome.[7],[8] As with any retrospective study, there is no randomization of treatments and hence less complicated fractures may be grouped in the closed reduction group, which would affect the distribution of mandibular fracture morbidity.[9],[10],[11]


  Conclusion Top


This study concludes that the higher the MISS, the higher the rate of complications in groups treated with ORIF. MISS however did not correlate much with groups treated with closed method. FLOSID taxonomy predicted the exact details of individual cases and helped in calculating MISSs.[12],[13] The overall complication rates were higher in the group treated with ORIF than in the group with closed reduction. Complication rates were statistically significant (0.65) in both groups. Majority of patients in the MMF group (64%) were in complication score zone 0 and 28% in the ORIF group were in the complication zone of 3 and 4, thereby indicating higher complication rates in groups treated with ORIF than with closed reduction. This indicates exact details of individual cases with complication score help the clinician to arrive and predict postoperative events, and to adopt proper treatment plan for individual cases to minimize the complication score as low as possible for the benefit of patients with trauma.[14],[15]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Der Matirosian C, Shetty V, Wang J, Belin TR. The Mandible Injury Severity Score: Development and validity. J Oral Maxillofacial Surg 2007;65:663-70.  Back to cited text no. 1
    
2.
Joos U, Meyer U, Tkotz T, Weingart D. Use of a mandibular fracture score to predict the development of complications. J Oral Maxillofac Surg 1999;57:2-5.  Back to cited text no. 2
    
3.
Mathog RH, Toma V, Clayman L, Wolf S. Non union of the mandible: An analysis of contributing factors. J Oral Maxillofac Surg 2000;58:746-52.  Back to cited text no. 3
    
4.
Atchinson K, Shetty V, Belin TR, Wang J. Clinician variability in characterizing mandible fractures. J Oral Maxillofac Surg 2001;59:254-61.  Back to cited text no. 4
    
5.
Gordon PE, Lawler ME, Kaban LB, Dodson TB. Mandibular fracture severity and patient health status are associated with postoperative inflammatory complications. J Oral Maxillofac Surg 2011;69:2191-7.  Back to cited text no. 5
    
6.
Moreno JC, Fernandez A, Oritz JA, Montanlvo JJ. Complication rates associated with different treatments for mandibular fracture. J Oral Maxillofac Surg 2000;58:273-80.  Back to cited text no. 6
    
7.
Senel FC, Jessen GS, Melo MD, Obeid G. Infection following treatment of mandible fractures: The role of immunosuppression and polysubstance abuse. Oral Surg Oral Med Oral Path Oral Radio Endo 2007;103:38-42.  Back to cited text no. 7
    
8.
Ellis E, Simon P, Throckmorton GS. Occlusal results after open or closed treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 2000;58:260-8.  Back to cited text no. 8
    
9.
Ellis E, Throckmorton G. Facial symmetry after closed and open treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 2000;58:719-28.  Back to cited text no. 9
    
10.
Kirkpatrick D, Gandhi R, Van Sickels JE. Infections associated with locking reconstruction plates: A retrospective review. J Oral Maxillofac Surg 2003;61:462-6.  Back to cited text no. 10
    
11.
Malanchuk VO, Kopchak AV. Risk factors for development of infection in patients with mandibular fractures located in tooth bearing areas. J Craniomaxillofac Surg 2007;35:57-62.  Back to cited text no. 11
    
12.
Maloney PL, Welch TB, Doku HC. Early immobilization of mandibular fractures. J Oral Maxillofac Surg 1991;49:698-702.  Back to cited text no. 12
    
13.
Gerbino G, Roccia F, De Gioanni PP, Berrone S. Maxillofacial trauma in elderly. J Oral Maxillofac Surg 1999;57:777-82.  Back to cited text no. 13
    
14.
Longwe EA, Zola MB, Bonnick A, Rosenberg D. Treatment of mandibular fractures via transoral 2.0mm miniplate fixation with 2 weeks of maxillomandibular fixation: A retrospective study. J Oral MaxillofacSurg 2010;68:2943-6.  Back to cited text no. 14
    
15.
Lamphier J, Ziccardi V, Ruvo A, Janel M. Complications of mandibular fractures in an urban teaching center. J Oral MaxillofacSurg 2003;61:745-9.  Back to cited text no. 15
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

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