Comparison of intraoral and extraoral approaches to mandibular angle fracture repair with cost implications

• Published in: The Laryngoscope 2016-03, Vol.126 (3), p.591-595
• Main Authors: Hsueh, Wayne D., Schechter, Clyde B., Tien Shaw, I, Stupak, Howard D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bone Plates; Cohort Studies; Confidence intervals; cost; Cost control; Cost estimates; Cost-Benefit Analysis; extraoral; Female; Follow-Up Studies; Fracture Fixation, Internal - economics; Fracture Fixation, Internal - methods; Fracture Healing - physiology; Humans; Injury Severity Score; intraoral; Jaw Fixation Techniques - economics; Jaw Fixation Techniques - instrumentation; Logistic Models; Male; Mandible fracture; Mandibular Fractures - diagnostic imaging; Mandibular Fractures - surgery; Natural Orifice Endoscopic Surgery - methods; Odds Ratio; Plastic surgery; Propensity Score; Proportional Hazards Models; Radiography; Retrospective Studies; Statistics, Nonparametric; Treatment Outcome; Young Adult
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.25405

Objectives/Hypothesis The objective of this study was to analyze outcomes of intraoral and extraoral approaches to mandibular angle fractures and provide cost estimates for comparison. Study Design A retrospective review from January 2005 to June 2013 was performed of patients who underwent open reduction internal fixation of mandibular angle fractures at a level I trauma center. Methods Patients were treated by three surgical specialties: otolaryngology–head and neck surgery, oral and maxillofacial surgery, and plastic and reconstructive surgery. Inpatient and outpatient medical records were reviewed for pertinent data including age, gender, duration of follow‐up, presence of other mandible fractures, surgical approach, surgical team, operative time, and postoperative complications. Results Of the 155 patients with mandibular angle fractures, 74% underwent open reduction internal fixation through an intraoral approach, whereas 26% of patients were treated with an extraoral approach. The occurrence of any complication was 69.6% in the extraoral group and 39% in the intraoral group (P = 0.009). In propensity‐weighted analysis, however, the occurrence of any complication was less frequent in intraoral cases but no longer statistically significant (odd ratio 0.28; 95% confidence interval, 0.08 to 1.02; P = 0.053). Operating room time was significantly shorter with the intraoral approach. We estimate that the intraoral approach directly saves at least $2,900 per case. Conclusion We recommend the use of an intraoral approach for the repair of mandibular angle fractures when clinically appropriate. This can result in a comparable rate of success, however, with significant cost savings to the health care system. Level of Evidence 4. Laryngoscope, 126:591–595, 2016