INCIDENCE AND RISK FACTORS FOR COMPLICATIONS AFTER MANDIBULAR OSTEOSYNTHESIS. A RETROSPECTIVE STUDY

Abstract

Purpose of the study. To conduct a retrospective analysis of the results of open repositioning and osteosynthesis in patients with traumatic fractures of the mandible, as well as to determine the frequency, structure and risk factors for postoperative complications in patients of this category. Materials and methods. The study included 344 patients with traumatic fractures of the mandible who underwent surgical treatment (osteosynthesis). The data taken into account were: gender, age of the patient, bad habits, concomitant somatic diseases, time from the moment of injury to hospitalisation and the patient's hospital stay, etiology and mechanism of injury, fracture location, type of fracture, presence of a tooth in the fracture gap, presence of a combined injury, surgical access, method of fixation (type and number of fixators), time of surgery, accuracy of fragment matching, presence and type of postoperative complications. The statistical analysis included the identification of factors associated with an increased risk of various types of complications. The Pearson's χ2 criterion was used to study differences in indicators that were qualitative or semi-quantitative in nature. To analyse the relationship between the risk of complications for patients who underwent surgery, univariate logistic regression models were built for each factor calculated using the EZR software (v.1.54). Results. Among the patients included in the study, men accounted for 87.7% (n=293) and women for 12.3 % (n=41). The age of the patients ranged from 18 to 80 years (mean age 34.7±12.1 years). Harmful habits were noted in 56.1 % (n=193) of patients. Concomitant somatic diseases were detected in 29.6 % (n=102) of cases. The predominant type of etiology was assaults ‒ 57.8 % (n=193). By localisation, fractures of the the angle (30.8 % (n=176), condyle (30.6 % (n=175), and the body (27.1 % (n=155)) prevailed. Combined trauma was present in 27.5 % (n=92) of patients. Teeth in the fracture gap were present in 153 cases of angle fractures (86.9 %), 134 cases of body fractures (86.5 %) and 52 chin fractures (100 %). Open repositioning of fragments in the studied patients was performed using intraoral access in 61.3 %. The overall incidence of postoperative complications was 11.2% (n=38).The main types of complications in the postoperative period included infectious purulent-inflammatory processes ‒ 3.6 % (n=12), plate fracture ‒ 1.2 % (n=4), disocclusion/ bite disorder, plate exposure and inferior alveolar nerve paresthesia ‒ 2.1 % (n=7) each. A statistically significant risk factor for complications after mandibular osteosynthesis was the accuracy of fragment repositioning (ꭓ2=13.73, p=.00021). There were two-factor features that were statistically significantly associated with the risk of complications in the postoperative period: an increase in the duration of surgery (p=0.03, 1.13 (95 % CI 1.01-1.27)) and a decrease in the accuracy of fragment repositioning (p=0.0004, 0.32 (95 % CI 0.172-0.6)). Conclusions. Thus, our study shows that the characteristics of the fracture and the chosen method of fixation practically did not affect the incidence of complications in the postoperative period. Instead, the main factors associated with an increase in the risk of postoperative complications in patients with mandibular fractures were an increase in the time of surgery and inaccurate repositioning.