Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 1, FI-00290, Helsinki, Finland.
Helsinki University Hospital, Haartmaninkatu 1A, FI-00029, Helsinki, Finland.
Oral Maxillofac Surg. 2024 Jun;28(2):839-847. doi: 10.1007/s10006-024-01213-6. Epub 2024 Jan 30.
To clarify reasons for infections, surgical techniques, and occurrence of postoperative surgical site complications in infected mandibular fractures.
Patients with clinically infected mandibular fracture of the dentate part without preceding surgery were studied retrospectively. Clinical infection was defined to occur if pus, abscess, or a fistula in the fracture area was present. Patient-, fracture-, and surgery-related variables were evaluated, and predictors for postoperative complications were analysed.
Of 908 patients with surgically treated fracture in the dentate part of the mandible, 41 had infected fracture at the time of surgery (4.5%). Of these patients, 46.3% were alcohol or drug abusers. Median delay from injury to surgery was 9 days. Patient-related factors were the most common cause for delayed surgery (n = 30, 73.2%), followed by missed diagnosis by a health care professional (n = 8, 19.5%). Twenty-two fractures were treated via extraoral approach (53.7%) and the remaining 19 intraorally (46.3%). Postoperative surgical site complications were found in 13 patients (31.7%), with recurrent surgical site infections predominating. Notable differences between total complication rates between intraoral and extraoral approaches were not detected. Secondary osteosynthesis for non-union was conducted for one patient treated intraorally.
Postoperative surgical site complications are common after treatment of infected mandibular fractures, and these occur despite the chosen surgical approach. Infected mandibular fractures heal mainly without bone grafting, and non-union is a rare complication. Due to the high complication rate, careful perioperative and postoperative care is required for these patients.
阐明感染原因、手术技术以及感染下颌骨骨折术后手术部位并发症的发生情况。
回顾性研究无术前手术史的临床感染性下颌骨有齿部骨折患者。如果骨折区域存在脓液、脓肿或瘘管，则定义为临床感染。评估患者、骨折和手术相关变量，并分析术后并发症的预测因素。
在接受手术治疗的下颌骨有齿部 908 例骨折患者中，有 41 例在手术时发生感染性骨折（4.5%）。这些患者中，46.3%为酗酒或吸毒者。从受伤到手术的中位延迟时间为 9 天。患者相关因素是导致手术延迟的最常见原因（n=30，73.2%），其次是医疗保健专业人员漏诊（n=8，19.5%）。22 例骨折采用口外入路（53.7%）治疗，其余 19 例采用口内入路（46.3%）。13 例患者（31.7%）出现术后手术部位并发症，以复发性手术部位感染为主。未发现口内和口外入路之间总并发症发生率的显著差异。1 例经口内治疗的患者行二期骨愈合。
感染性下颌骨骨折治疗后手术部位并发症常见，尽管选择了手术入路，但仍会发生。感染性下颌骨骨折主要无需植骨愈合，且不愈合是罕见的并发症。由于并发症发生率高，这些患者需要进行仔细的围手术期和术后护理。
