Facial Fracture Repair in the Traumatic Brain Injury Patient

Shibuya, Terry Y.; Karam, Amir M.; Doerr, Timothy; Stachler, Robert J.; Zormeier, Michele; Mathog, Robert H.; McLaren, Christine L.; Li, Kuo-Tung

doi:10.1016/j.joms.2006.06.309

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 65, Issue 9 , Pages 1693-1699, September 2007

Facial Fracture Repair in the Traumatic Brain Injury Patient

Terry Y. Shibuya, MD
- Assistant Clinical Professor, Department of Head and Neck Surgery, Southern California Kaiser-Permanente Medical Group, Orange County, CA.
- Address correspondence and reprint requests to Dr Shibuya: Department of Head and Neck Surgery, 411 Lakeview Ave, Anaheim, CA 92807
Amir M. Karam, MD
- Resident, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine College of Medicine, Orange, CA.
Timothy Doerr, MD
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Rochester University School of Medicine, Rochester, NY.
Robert J. Stachler, MD
- Assistant Professor, Department of Otolaryngology/Head & Neck Surgery, Wayne State University School of Medicine, Detroit, MI.
Michele Zormeier, MD
- Resident, Department of Otolaryngology/Head & Neck Surgery, Wayne State University School of Medicine, Detroit, MI.
Robert H. Mathog, MD
- Professor, Department of Otolaryngology/Head & Neck Surgery, Wayne State University School of Medicine, Detroit, MI.
Christine L. McLaren, PhD
- Professor, Department of Medicine, Division of Epidemiology and Chao Family Comprehensive Cancer Center, University of California Irvine College of Medicine, Orange, CA.
Kuo-Tung Li, MS
- Staff Statistician, Chao Family Comprehensive Cancer Center, University of California Irvine College of Medicine, Orange, CA.

Purpose

To review the surgical complications of patients who had facial fractures repairs in the setting of a traumatic brain injury (TBI).

Patients and Methods

A review of all individuals admitted with the diagnosis of TBI based on an evaluation by the neurotrauma service who also underwent facial fracture repair was performed. More than 600 charts were reviewed and 99 patients met study criteria. Univariate and mulitvariate logistic regression model analysis were performed comparing the complication rate in the immediate postoperative period to the patients’ age, gender, mechanism of injury, zone of facial injury, preoperative Glasgow Coma score, presence of multisystem injury, mechanism of TBI and treatment, length of time from injury to surgical repair and length of surgical procedure.

Results

Of the 99 individuals studied, there was an 11% complication rate (8 minor, 3 major) in the immediate postoperative period. After univariate analysis, the length of time from injury to surgical repair, zone 1 facial injury and low Glasgow Coma score were all factors associated with increased complications. Multivariate logistic regression model analysis revealed that the odds of a patient sustaining a postoperative complication was 1.298 as the hour of procedure increased by 1 hour (95% CI, 1.065-1.582) and was 1.152 as the days of repair increased by 1 day (95% CI, 1.030-1.288).

Conclusions

The overall complication rate of facial fracture repair in the TBI patient was 11%. A prolonged surgical procedure and delay in surgical repair were associated with higher complication rates as identified by multivariate logistical regression analysis.