Is Distance Between Home and Treatment Site a Risk Factor for Complications After Treating Mandibular Fractures?

PURPOSE: Our level I trauma center provides care over a large geographic area including Alaska, Washington, Idaho, Montana, and Wyoming, with many patients traveling hundreds of miles to receive care. Distance to a treatment site is documented to be an independent risk factor for complications after multisystem trauma, but it is unclear if it is a risk factor for isolated mandibular fractures. The study purpose was to measure the association between distance to treatment site and risk for postoperative complications after treatment of isolated mandibular fractures. MATERIALS AND METHODS: The investigators designed and implemented a retrospective cohort study and enrolled a sample derived from patients treated for isolated mandibular fractures at Harborview Medical Center by the oral and maxillofacial surgery service between June 2012 and December 2016. The primary predictor variable was distance (miles) between the patient's residence and site of treatment (Harborview Medical Center). The primary outcome variable was postoperative complication (yes or no), subcategorized as major and minor. Secondary outcome variables were time to treatment between injury and operative treatment (days) and length of hospital stay (LOS) (days). Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between distance to treatment site and postoperative complications, time to treatment, and LOS. The level of statistical significance was set at P ≤ .05. RESULTS: The study sample was composed of 403 subjects with a mean age of 32.6 ± 14.3 years and 80% were men. The average distance from the patient's residence to treatment site was 44.8 ± 128.6 miles (range, 0 to 1,440 miles; median, 20.4 miles). Major complications occurred in 11.6% of patients. The average distance between patients with and without postoperative complications was not significantly different (42.3 ± 55.8 miles vs 45.5 ± 141.7 miles; P = .8). Increasing distance was significantly associated with longer LOS (r = 0.16; P < .001) but not time to treatment (r = .04; P = .4). CONCLUSIONS: In contrast to other studies regarding multisystem trauma, complications after treating isolated mandible fractures were not associated with increasing distance to treatment site. Increasing distance may be associated with longer LOS but not time to treatment.

Why Is Mandibular Third Molar Coronectomy Successful Without Concurrent Root Canal Treatment?

PURPOSE: Coronectomy is performed to avoid injury to the inferior alveolar nerve when mandibular third molars (M3s) in close proximity to the inferior alveolar nerve are indicated for extraction. Concern has been raised regarding the fate of submerged roots with exposed pulp tissue and whether this will serve as a nidus for infection. The study purpose was to answer the following clinical question: Among patients undergoing coronectomy, do those treated with concurrent root canal treatment (RCT), when compared with those not treated with RCT, have a decreased frequency of postoperative infections? The specific aims of this study were to 1) perform a comprehensive review to compare postoperative infection rates in M3 coronectomies with and without concurrent RCT and 2) review relevant animal and human studies pertaining to pulpal physiology as it relates to coronectomy. MATERIALS AND METHODS: The study was designed as a comprehensive review to identify controlled studies that compared outcomes of M3 coronectomies with and without concurrent RCT published through January 2020. Studies included in the sample needed to meet the following criteria: 1) studies published in English, 2) human studies, and 3) studies that reported the postoperative infection outcomes. The predictor variable was concurrent RCT at the time of coronectomy. The outcome variable was postoperative infection. RESULTS: The database search identified 107 publications for initial review. After application of the inclusion and exclusion criteria, the final sample included only 1 publication. The frequencies of postoperative infection with and without concurrent RCT were 87.5% and 12.5%, respectively. CONCLUSIONS: The one study identified for detailed review showed that RCT at the time of coronectomy does not decrease the frequency of postoperative infections. This result supports the recommendation that it is unnecessary to perform concurrent RCT on M3 roots that are retained. The finding that intentional submersion of roots does not require RCT also is supported by multiple animal and human studies.

Is the Mandible Injury Severity Score a Valid Measure of Mandibular Injury Severity?

PURPOSE: Developing a valid method for assessing mandibular injury severity could permit standardized comparisons of treatment-specific outcomes between and among various mandibular fracture studies. The study purpose was to assess the validity of the Mandible Injury Severity Score (MISS) developed by Shetty et al (J Oral Maxillofac Surg 65:663, 2007) by measuring the association between the MISS and postoperative complications, operative time, and length of hospital stay (LOS) after operative treatment of isolated mandibular fractures. MATERIALS AND METHODS: The authors designed and implemented a retrospective cohort study and enrolled a sample derived from patients treated for isolated mandibular fractures at Harborview Medical Center (Seattle, WA) by the oral and maxillofacial surgery service from June 2012 through December 2016. The primary predictor variable was the MISS. The primary outcome variable was postoperative complication (yes or no). Secondary outcome variables were operative time and LOS. Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between the MISS and postoperative complications. The level of statistical significance was set at a P value less than or equal to .05. RESULTS: The study sample was composed of 415 patients with a mean age of 32.7 ± 14.3 years and 80% were men. The average MISS was 13.4 ± 3.5 (range, 6 to 25). The postoperative complication rate was 21%. The average MISS was significantly higher in patients with postoperative complications than in patients without complications (16.3 ± 3.3 vs 12.6 ± 3.1; P < .001). In the adjusted model, postoperative complications were significantly associated with an increasing MISS (odds ratio [OR] = 1.4; 95% confidence interval [CI], 1.3-1.6; P < .001) and open treatment (OR = 7.6; 95% CI, 1.6-35.6; P = .01). The MISS was positively correlated with operative time (r = 0.529; P < .001) and LOS (r = 0.114; P = .02). CONCLUSION: The results of this study suggest that the MISS may be a valid measurement of mandibular injury severity as evidenced by the positive correlation between the MISS and postoperative complications, duration of operation, and LOS.

OFIRMEV: an old drug becomes new again.

This was judged to be the first place winning submission for the American Dental Society of Anesthesiology Student Essay Award. Acetaminophen is an old drug that is now available in an intravenous formulation. Its advantages and disadvantages are reviewed, including its potential role in multimodal postoperative pain therapy.