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| ORIGINAL ARTICLE |
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| Year : 2019 | Volume
: 7
| Issue : 1 | Page : 12-14 |
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A clinical assessment of postoperative complications of mandibular fractures using Mandibular Injury Severity Score at K. R. Hospital, Mysore
S Sandeep Tejaswi, TS Subash
Department of Dentistry, K. R. Hospital, Mysore, Karnataka, India
| Date of Web Publication | 26-Jun-2019 |
Correspondence Address:
Dr. T S Subash
Department of Dentistry, K. R. Hospital, Mysore 570 001, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/INJO.INJO_10_19
Introduction: Among the facial injury, the mandibular fractures represent a substantial portion of surgical case load to trauma centers. Management of this common injury varies greatly and is still driven by expert opinion or empirical data. Scientific study of mandible fractures and their treatment has been hampered by the lack of an injury cataloging system that allows a disciplined, systematic aggregation of collective clinical experiences. Materials and Methods: A prospective study was conducted in the Department of Dentistry, Mysore Medical College and Research Institute, Karnataka, Mysore, India. Subjects selected were above 16 years of age with isolated mandibular fractures who were eligible to undergo treatment. A total of 50 patients were divided into two groups, closed and open reduction, each having 25 subjects. Each individual case was evaluated for FLOSID components separately. Mandibular Injury Severity Score (MISS) was assigned based on summated results of FLOSID components. Obtained complication scores and MISS were correlated statistically using Spearman’s correlation coefficient among the different groups. Results: On comparison between the two groups, open reduction and internal fixation (ORIF) and maxillomandibular fixation (MMF), statistical analysis using Mann–Whitney U test showed mean and median values for the ORIF group as 6.52 and 5 (3–11), respectively whereas mean (SD) and median values in the MMF group as 5.52 (3.31) and 5 (3–3.5), respectively. There was proportional increase in both MISS and complication score. The aforementioned analysis indicates that MISS is a predictable parameter in assessing postoperative complications of mandibular fracture and also in predicting the complication outcomes in clinical situation. Conclusion: This study concludes that the higher the MISS, the higher the rate of complications in groups treated with ORIF. MISS however did not correlate much with groups treated using closed method. FLOSID taxonomy predicted the exact details of cases and helped arriving at MISSs, of individual cases with complication score to help the clinician to arrive and predict postoperative events, and to adopt proper treatment plan for individual cases, to minimize the complication score as low as possible, for the benefit patients with Maxillofacial trauma. Keywords: FLOSID, mandibular fracture, Mandibular Injury Severity Score, ORIF, taxonomy
How to cite this article:
Sandeep Tejaswi S, Subash T S. A clinical assessment of postoperative complications of mandibular fractures using Mandibular Injury Severity Score at K. R. Hospital, Mysore. Int J Oral Care Res 2019;7:12-4 |
How to cite this URL:
Sandeep Tejaswi S, Subash T S. A clinical assessment of postoperative complications of mandibular fractures using Mandibular Injury Severity Score at K. R. Hospital, Mysore. Int J Oral Care Res [serial online] 2019 [cited 2023 Mar 24];7:12-4. Available from: https://www.ijocr.org/text.asp?2019/7/1/12/259919 |
| Introduction | |  |
Among the facial injury, the mandibular fractures represent a substantial portion of surgical case load to trauma centers. Management of this common injury varies greatly and is still driven by expert opinion or empirical data. Occurrence of postoperative complications continues to plague oral and maxillofacial surgeons regardless of technique used. Complications are of major or minor consequence but have the potential to develop into more significant, including debilitating pain, malunion, nonunion, chronic osteomyelitis, acquired skeletal deformities, extended hospital stay, and financial burden. Scientific study of mandible fractures and their treatment has been hampered by the lack of an injury cataloging system that allows a disciplined, systematic aggregation of collective clinical experiences.[1]
Purpose of the study
The purpose of this study were to evaluate anatomical and morphological characteristics of mandibular fractures in clinical presentation and to classify the type and location of fracture using FLOSID taxonomy, to evaluate the validity by relating to a variety of clinical complications and their outcomes, and to compare the Mandibular Injury Severity Score (MISS) to complication rates in different treatment methods for mandibular fractures.
| Materials and Methods | | |
Source of data
A prospective study was conducted in the Department of Dentistry, Mysore Medical College and Research Institute, Mysore, Karnataka, India.
Method
The subjects aged older than 16 years with mean average age of the groups being 25.7 years were included in this study. Each individual case was evaluated for FLOSID components separately. MISS was assigned based on summated results of FLOSID components. Six injury attributes that were significant for directing care and influencing outcomes are denoted with an acronym as FLOSID: F (fracture type), L (location of fracture), O (occlusion), S (soft tissue damage), I (infection), D (interfragmentary displacement).
FLOSID taxonomy table
It is taken as mild (<2mm), moderate (2–4mm), and severe (>4mm).[5] Each case was evaluated for individual components of FLOSID, and the corresponding MISS was tabulated. Obtained complication scores and MISSs among different groups were correlated statistically using Spearman’s correlation coefficient.
| Results | | |
A total of 50 patients were divided into two groups, one group treated with open method, that is, open reduction and internal fixation (ORIF) and the other group treated with closed method with maxillomandibular fixation (MMF). Each group had 25 subjects. For each case, treatment plan was based purely on surgeon’s decision. After the treatment, closed or open reduction of fractures in individual cases was evaluated clinically to assess the postoperative complications. Cases were examined immediately after treatment, after 1 week, and after 1 month. Each case was assigned to FLOSID components and accordingly MISS was assigned.[1],[2]
The MISS did not differ significantly among patients who received ORIF (median = 5) and those who were treated by closed reduction (median = 5) with P value = 0.6.
On comparison between the two groups, showed mean and median values in the ORIF group as 6.52 and 5 (3–11), respectively, whereas the MMF group showed mean (SD) and median as 5.52 (3.31) and 5 (3–3.5), respectively. The MISS did not differ significantly among patients who received ORIF (median = 5) and those who received MMF (median = 5) with a P value of 0.6. Of the patients, 64% treated with closed reduction and 24% treated with ORIF fell in complication score zone of 0, indicating that the group treated with closed methods had significantly less complication score than the group treated with ORIF. Of the patients, 28% treated with ORIF fell in the complication score zone of 3, indicating that maximum complications that all patients had were malunion or malocclusion clinically. On comparing mean MISS and complication scores among the groups treated with closed method and ORIF, it was observed that as the MISS increased, complication score increased proportionately: 6.52 (ORIF) to 5.52 (MMF) [Table 1]. Complication score was 2.36 in the ORIF group and 0.96 in the MMF group [Table 2]. There was proportional increase in both MISS and complication score. The aforementioned analysis indicates that MISS is a predictable parameter in assessing postoperative complications of mandibular fracture and also in predicting the complication outcomes in clinical situation [Figure 1]. | Table 1: Comparison of MISSs among patients receiving ORIF and closed reduction
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,  | Table 2: Comparison of complication scores among patients receiving ORIF and closed reduction
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| Discussion | | |
Beyond communicating a reliable verbal image of the injury, such a system would serve as a basis for quantifying anatomic severity, help guide treatment, and predict and allow reporting or comparison of outcomes across patients and institutions.[3] The current climate of evidence-based clinical practice and extramural audit of quality of care and cost-effectiveness impose an urgency to develop more precise metrics for cataloging mandible fractures and establishing severity scoring to facilitate trauma care and research for better communication.[4],[5] This study showed that the complication rates remain higher with open reduction; however, MISS did not show much difference for groups treated with MMF, which is well coincided with other studies.[6] With improved plating systems and improved operator experience, closed reduction of mandibular fractures is the method with lowest incidence of postoperative complications of mandibular fractures. However, most complications were minor and resulted in eventual favorable outcome.[7],[8] As with any retrospective study, there is no randomization of treatments and hence less complicated fractures may be grouped in the closed reduction group, which would affect the distribution of mandibular fracture morbidity.[9],[10],[11]
| Conclusion | | |
This study concludes that the higher the MISS, the higher the rate of complications in groups treated with ORIF. MISS however did not correlate much with groups treated with closed method. FLOSID taxonomy predicted the exact details of individual cases and helped in calculating MISSs.[12],[13] The overall complication rates were higher in the group treated with ORIF than in the group with closed reduction. Complication rates were statistically significant (0.65) in both groups. Majority of patients in the MMF group (64%) were in complication score zone 0 and 28% in the ORIF group were in the complication zone of 3 and 4, thereby indicating higher complication rates in groups treated with ORIF than with closed reduction. This indicates exact details of individual cases with complication score help the clinician to arrive and predict postoperative events, and to adopt proper treatment plan for individual cases to minimize the complication score as low as possible for the benefit of patients with trauma.[14],[15]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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[Figure 1]
[Table 1], [Table 2]
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