Source:Journal of Oral and Maxillofacial Surgery
Author(s): Benjamin T. Ostrander, Howard D. Wang, Alessandro Cusano, Paul N. Manson, Arthur J. Nam, Amir H. Dorafshar
PurposeNonunion is an uncommon complication after mandible fractures. The purpose of this investigation was to compare outcomes of patients with mandibular fracture nonunion who were treated with a single-stage versus two-stage approach, and propose a pragmatic treatment algorithm for surgical management based on preoperative characteristics.MethodsInvestigators conducted a retrospective study consisting of patients who presented to two Level-1 trauma centers for the management of mandibular fracture nonunion over a 10-year period. The primary predictor variable was one-stage versus two-stage treatment. Outcomes were examined to propose a treatment algorithm.ResultsEighteen patients were included into the study. The sample's mean age was 44.0 ± 19.3 years, and most were male (88.9%). Mandibular angle and body accounted for 77.8% of cases. A single-stage approach was used in 13 patients (72.2%). Bone grafts or vascularized bone flaps were required in 13 patients (72.2%). Patients who required two-stage treatments had intraoral soft tissue defects. Mean length of follow-up was 13.3 ± 20.4 months. All patients achieved bony union, with complications occurring in 5 patients (27.8%). Our 10-year experience was used to formulate a treatment algorithm based on bony defect size and soft tissue status, which can be used to inform optimal surgical management.ConclusionsNonunion of mandibular fractures is an infrequent and complex condition requiring careful and deliberate surgical management. A single-stage approach is appropriate in most cases and does not negatively affect outcomes. Bony defect size and soft tissue status are essential parameters for determining approach and timing of reconstruction.
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