Purpose
Patients with mandibular fractures are known to be at risk of concomitant cervical
spine injuries (CSIs). The purpose of this study was to determine the incidence of
and risk factors for CSIs in these patients.
Patients and Methods
We conducted a retrospective cohort study of adult trauma patients with mandibular
fractures from June 1, 2007, through June 30, 2017. Patients were identified through
the Massachusetts General Hospital trauma registry and were included as study patients
if they had a mandibular fracture and computed tomography or magnetic resonance imaging
of the cervical spine. The primary predictor variable was the site of the mandibular
fracture; the primary outcome variables were the presence of CSIs and death. The other
variables were demographic characteristics (age, gender, alcohol use, and drug use),
Injury Severity Score, Glasgow Coma Scale, presence of midface and extra-craniofacial
injuries, and etiology. Data analysis consisted of univariate correlations and construction
of a multivariate model to determine independent risk factors for CSIs.
Results
Of 23,394 patients in the trauma registry, 3,950 (17%) had craniomaxillofacial fractures
and 1,822 (7.7%) had CSIs. The frequency of CSIs in the overall cohort of mandibular
fracture patients (n = 1,147) was 4.4%, and for admitted patients (n = 495), it was
10%. The mean age of patients with mandibular fractures plus CSIs was 40 years (range,
19 to 93 years); 84% were men. Patients with a ramus-condyle unit fracture, mandibular
fracture plus any midface fracture, non–craniomaxillofacial injury, and motor vehicle
crash etiology had the highest frequency of CSIs. Ramus-condyle unit fractures and
chest injuries were independent risk factors for CSIs in the multivariate model (P = .0334 and P = .0013, respectively). The mortality rate was 4-fold higher in patients with CSIs
versus those without CSIs.
Conclusions
The presence of ramus-condyle unit fractures and the presence of chest injuries were
independent risk factors for CSIs. Oral and maxillofacial surgeons should be diligent
in ruling out CSIs in mandibular fracture patients.
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Article Info
Publication History
Published online: August 07, 2018
Accepted:
July 31,
2018
Received:
June 14,
2018
Footnotes
This project was funded in part by the Massachusetts General Hospital Department of Oral & Maxillofacial Surgery Education and Research Fund, as well as Finnish Dental Society Apollonia and Helsinki University Hospital Funds.
Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.
Identification
Copyright
© 2018 American Association of Oral and Maxillofacial Surgeons
