Intraoral Wound Dehiscence After Open Reduction Internal Fixation of Mandibular Fractures

A Retrospective Cohort Study

Shadia Abdelhameed Elsayed, PhD; Abdel Aziz Baiomy Abdullah, PhD; Najla Dar-Odeh, FDS RCS; Alaa Abdelqader Altaweel, PhD

Disclosures

Wounds. 2021;33(3):60-64. 

In This Article

Abstract and Introduction

Abstract

Introduction. The high prevalence of intraoral wound dehiscence (IOWD) following open reduction internal fixation of mandibular fractures has not been well studied.

Objective. A retrospective cohort study was conducted to investigate and assess possible risk factors for IOWD related to patients and surgical technique.

Methods. All patients who did not have diabetes, were not medically compromised such as patients with nutritional deficiencies or endocrine disorders, did not smoke, did not consume alcohol, and had mandibular fractures managed through open reduction internal fixation and via intraoral vestibular incision from January 2007 to December 2019, at Al-Azhar University Hospitals, in Cairo, Egypt were included in the study. Study data were collected and grouped according to the demographic characteristics of patient age and sex and fracture-related factors of cause, side, site, displacement severity, fixation device, infection, and history of dehiscence. Follow-up of all patients was conducted daily during the first week and weekly during the first month after surgery. Data were analyzed using cross-tabulation with Pearson chi-squared test to calculate the significance of associations between various independent variables and occurrence of IOWD; P less than or equal to .05 was viewed as statistically significant.

Results. The study included 69 mandibular fracture patients (age range, 13–55 years [mean, 28.13 ± 11.5 years]) treated using different osteosynthesis fixation devices, including miniplates, lag screws, and heavy locking plates. No statistically significant differences were noted between groups in terms of age, sex, and surgical attributes of fracture site, displacement severity, or fixation type with regard to IOWD (P > .05). None of the included patients were medically compromised, smoked, or used alcohol. Intraoral wound dehiscence occurred in 7 patients (10.1%) and was managed conservatively through copious irrigation with warm saline and chlorhexidine mouthwash in intermittent cycles of 5 times a day for 2 weeks; when infection was present, antibiotic prescription and drainage were provided. Complete wound closure was achieved after a maximum period of 2 weeks.

Conclusions. A small proportion of mandibular fracture patients are expected to have IOWD complication even if a meticulous and appropriate surgical technique is implemented. Intraoral wound dehiscence has a good prognosis and it may require a maximum of 2 weeks to obtain healing with secondary epithelization of the bared bony sites.

Introduction

Currently, the mandible is the second most frequently fractured adult facial bone, making it an important consideration for the maxillofacial surgeon.[1] Increased understanding of risk factors and the development of surgical techniques have markedly reduced post operative complications associated with mandibular fractures.[2,3] However, patients continue to experience postoperative complications such as intraoral wound dehiscence (IOWD). This complication is defined as separation of the margins of a closed surgical incision, with or without exposure of the underlying bone, usually occurring 3 to 7 days postoperatively.[4–6] When compared to cutaneous dehiscence, IOWD demonstrates accelerated healing and reduced scar formation;[7] however, IOWD is considered a troublesome postoperative sequel for both the surgeon and the patient because the bone surface is exposed to a variety of irritants and infective agents, subsequently delaying healing. Moreover, patients are adversely affected by other factors such as increased treatment cost, prolonged hospital stay, and the additional costs of sick leave.[8]

The prevalence of IOWD in Egypt is estimated to be 20% in angle mandibular fractures and 17% in the anterior symphyseal/parasymphyseal regions.[9,10] Despite this relatively high prevalence, IOWD is not a thoroughly investigated complication and no acceptable classification or management protocol has yet been identified.[11]

More data are needed on the risk factors of IOWD among the medically fit individuals who constitute the majority of trauma patients. Investigating postoperative complications in patients with fractures requires special attention in Egypt, a heavily populated country with a high rate of road traffic accidents that constitute a major cause of mandibular fractures.[10,12] In Egypt, it is estimated that 50% of the total number of facial fractures affect the mandible.[13] Therefore, updating guidelines would be helpful for the prevention and management of IOWD.

The present study aimed to determine the prevalence of IOWD that develops after treatment of mandibular fractures and to report the possible associated surgical factors in a cohort of medically fit patients. The study hypothesized that patient age, sex, fracture site, degree of displacement, and fixation type have no effect on IOWD prevalence.

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