Open Mandible and Maxillary Fractures Associated with Higher Risk of Infection in Victims of Violence

Author(s):
Melissa Canas; Ricardo Fonseca; Leonardo Diaz; Jose Aldana; Hussain Afzal; Jennifer Leonard; Kelly Marie Bochicchio; Grant Bochicchio

Background:

Interpersonal violence is a common mechanism of injury in trauma patients. Fractures of the jawbones are commonly the result of these violent altercations. They represent a complex challenge due to possible compromise of the airway, and infection-related complications due to potential involvement of the oral cavity.

Hypothesis:

We hypothesized that open mandible and maxillary fractures in victims of violence (VOV) are associated with a higher rate of infection as compared to non-VOV patients with open facial fractures.

Methods:

We queried our prospectively maintained Trauma Registry from 2005 to 2020 for patients admitted to our Level one trauma center with the diagnosis of open mandible and maxillary fractures. We abstracted demographics, fracture location, cultures, infectious complications (abscesses, wound infections, and osteomyelitis), and antibiotic treatments. Standard antibiotic prophylaxis during the study period included Clindamycin, Ampicillin-Sulbactam, or Cefazolin. We excluded patients with AIS scores >2 in other anatomical regions. We stratified patients into two groups: VOV (penetrating and blunt assault) and non-VOV (falls, MVC/MCC, pedestrian struck). We subsequently analyzed these two groups with Chi-Square and Student t-test using SPSS.

Results:

We identified 316 patients with open mandible and maxillary fractures.  198 patients (62.7%) were identified as being VOV, and 118 (37.3%) patients were non-VOV. 234 (74.1%) of these patients were diagnosed with open mandible fractures, 25 (7.9%) had open maxillary fractures and 57 (18%) had both. All of these fractures were isolated or associated with other facial fractures. 19/316 (6.0%) patients were diagnosed with infection related to the fracture (63.2% abscesses, 31.6% wound infections, and 26.3% osteomyelitis). Although ISS was higher in non-VOV patients (5.8 ±2.6 vs 4.9 ±1.8, p 0.013), 17/19 infections (89.5%, p<0.013) were in the VOV cohort.

Conclusions:

Open fractures of the mandible and maxilla as a result of VOV (blunt or penetrating mechanism of injury) are associated with a greater risk of infection as compared to non-VOV mechanisms of injury. These violent mechanisms of injury should alert the clinician of this greater risk and potentially institute more aggressive methods of infection prevention.  Further research is needed to prevent this high risk of infection.