SA4 - Mandible Fracture Patterns after Low Kinetic Energy Trauma Common in an Urban Level I Trauma Center

Abstract: Statement of problem: Facial trauma and fractures are injuries that may require attention from emergency departments (ED). The Nationwide Emergency Department reported that in 2007 alone 407,167 ED visits included a facial fracture, with annual costs close to $1 billion.1 Of these, 1 of the most common injury sites of the maxillofacial region is the mandible.2 Despite previous studies having shown trends in etiology, epidemiology, and treatment outcomes, there is still no consensus on culture-, city-, and facility-specific variables by reporting trauma centers.3 For example, some studies mention motor vehicle accidents and interpersonal violence as leading causes of mandibular fractures, while other studies list falls, all with varying geographic influences as well. Therefore, this study aims to provide surgeons with a better understanding of evolving trends and outcomes in the etiology and management of adult mandible fractures in the metropolitan population of New York City (NYC). It is especially important to reevaluate trends in this population because of the changing climate of NYC. The main aim of this study is to evaluate the patient experience, in terms of demographics, clinical characteristics, and treatment patterns.

Materials and methods: The researchers conducted a retrospective chart review to analyze the facial trauma of patients treated at NY-Presbyterian/Weill Cornell Medical Center between 2008 and 2017. Charts of patients with specific ICD-9/ICD-10 codes were reviewed for patient demographics, injury characteristics, and provider information. Researchers found 3946 facial fractures in 1914 patients who presented from 2008 to 2017. Within this, those with mandibular fractures were studied in detail. A logistic regression model was built to characterize the demographic trends, injury mechanisms, and rendered treatments.


Results: Of the 1914 patients who suffered facial trauma in this study, 19.9% (382) suffered a mandible fracture. Many of the patients suffered more than 1 mandible fracture for a total of 577 fractures. Of these mandible fractures, 70% occurred in men, 30% occurred in women, and the most common site of mandible fracture was the ramus/angle of the mandible (29.97%) (Figure 1). The median age of patients who sustained a mandible fracture was 33 with a range of 23 to 56. The most common mechanism of injury for facial fractures involving the mandible was falls. Of all the mandible fractures reviewed, oral and maxillofacial surgery was the treating service for 70.9% (271) of all the fractures involving the mandible; 73.9% (176) of all mandible fractures were treated with a combination of open reduction internal fixation and closed reduction intermaxillary fixation.


Conclusion: This represents 1 of the largest comprehensive datasets on facial fractures. While mostly consistent with other studies, 1 major difference was the mechanism of injury. Unlike existing literature, which primarily characterizes high-velocity mechanisms such as motor vehicle accidents, this urban patient population was most likely to be affected by low-velocity injury mechanisms such as falls. This may be representative of other major metropolitan centers in the United States as well, helping to better understand current management trends.


References:

1. VandeGriend ZP, Hashemi A, Shkoukani M: Changing trends in adult facial trauma epidemiology. Journal of Craniofacial Surgery 26(1):108-112, 2015
2. Morris C, et al: Mandibular fractures: an analysis of the epidemiology and patterns of injury in 4143 fractures. Journal of Oral and Maxillofacial Surgery 73(5):951-e1, 2015
3. Afrooz, PN, et al: The epidemiology of mandibular fractures in the United States, part 1: a review of 13,142 cases from the US National Trauma Data Bank. Journal of Oral and Maxillofacial surgery 73(12):2361-2366, 2015