Risk Factors for Cervical Spine Injury in Patients with Mandibular fractures

Publication date: Available online 7 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Esa M. Färkkilä, Zachary S. Peacock, R.John Tannyhill, Laurie Petrovick, Alice Gervasini, George C. Velmahos, Leonard B. Kaban

Abstract

Purpose

Patients with mandibular fractures are known to be at risk for concomitant cervical spine injuries (CSI). The purpose of this study was to determine the incidence and risk factors for CSI in these patients.

Patients and Methods

We conducted a retrospective cohort study of adult trauma patients with mandibular fractures from June 1, 2007 through June 30, 2017. Patients were identified through the Massachusetts General Hospital Trauma Registry and were included as subjects if they had a mandibular fracture and computed tomography (CT) or magnetic resonance imaging (MRI) of the cervical spine. Primary predictor variable was site of mandibular fracture; outcome variables were presence of CSI and mortality. Other variables were: Demographic (age, gender, alcohol and drug use, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), presence of mid-face and extra-craniofacial injuries and etiology. Data analysis consisted of univariate correlations and construction of a multivariate model to determine independent risk factors for CSI.

Results

Of 23,394 patients, in the Trauma Registry, 3950 (17%) had craniomaxillofacial fractures (CMF) and 1822 (7.7%) CSI. The frequency of CSI in the overall cohort of mandibular fracture patients (n=1147) was 4.4% and for admitted patients (n=495) 10%. Mean age of patients with mandibular fractures + CSI was 40 years (19-93); 84% were male. Subjects with a ramus-condyle unit fracture, mandible + any mid-face fracture, non-CMF injuries and motor vehicle crash (MVC) etiology had the highest frequency of CSI. Ramus-condyle unit fracture and chest injury were independent risk factors for CSI in the multivariate model (p=0.0334 and 0.0013, respectively). Mortality was four-fold higher in subjects with CSI versus those without CSI.

Conclusion

The presence of ramus-condyle unit fractures and chest injury were independent risk factors for CSI. Oral and maxillofacial surgeons should be diligent in ruling out CSI in mandibular fracture patients.

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