Characteristics Associated With Increased Complications of Maxillomandibular Fixation at an Urban Level I Trauma Center

Introduction: Maxillomandibular fixation (MMF) is used frequently for mandibular trauma reconstruction, and there is limited high-quality data published on its complications. This investigation seeks to identify risk factors for increased complication rates in maxillomandibular fixation in mandibular fracture repair at an urban level I trauma center.

Methods: A retrospective chart review was performed on 539 patients who underwent maxillomandibular fixation during repair of traumatic mandibular fractures from 2014 through 2019. Exclusion of 156 patients occurred due to pre-operative infection, surgery over sixty days from injury, edentulous status, and removal of MMF prior to leaving the operating room. The primary outcome was presence of complication, defined as emergency department presentation, readmission, malocclusion, malunion or non-union, post-operative infection, and hardware exposure or failure. Demographic and fracture characteristics were compared using Fischer’s exact test, Kruskal Wallis test, and multivariate logistic regression.

Results: There were increased MMF complications upon univariate analysis in patients with active smoking (p <.001), alcohol abuse history (p=0.021), and drug use (p=0.001). There were trends toward significance with incarcerated status (p=0.072), comorbid psychiatric illness (p=0.054), and uninsured status (p=0.051). Upon multivariate logistical regression, smoking shows a striking significance above all other variables. There was no statistical significance for increased complications with age, sex, race, concurrent dental extractions during reduction, or duration from injury to repair.

Conclusions: Smoking is the factor most associated with complications in patients left in MMF after mandibular fracture repair in this patient population. Alcohol abuse history, drug use, incarceration, comorbid psychiatric illness, and insurance status should also be considered when determining an optimal reconstructive plan.