[Enteral feeding by nasogastric tube in mandibular fracture osteosynthesis].
BACKGROUND
Mandibular fractures are among the most common fractures of the face; their treatment consists in a reduction by intermaxillary blocking then miniplate osteosynthesis. In our unit we systematically insert a nasogastric tube for enteral feeding to improve nutrition and to protect healing. Since the beginning of 2002, a series of patients operated for simple mandibular fractures were fed immediately after the operation by a semiliquid food. The purpose of this work is to verify the real advantage of enteral feeding by nasogastric tube in patients operated for simple fractures of the mandible.


METHODS
This retrospective study includes all the patients operated for closed fractures of the toothed portion of the mandible from January 1999 to October 2003. There were two series, a first series of patients operated between 1999 and 2002 fed by nasogastric tube until mouth healing and the second series of patients operated between 2002 and 2003 fed by mixed oral-enteral nutrition from the first postoperative day. We analyzed demographic features, time between trauma and operation, type of fracture, feeding modalities, duration of use of the nasogastric tube, duration of hospital stay and postoperative complications.


RESULTS
A total of 111 patients were included in the study. The first group of 81 patients fed by nasogastric tubes included 19 women and 62 men with an average age of 29.7 years (from 15 to 81 years). The average time from trauma to operation was 2.3 days (0 to 5 days), the feeding by nasogastric tubes was maintained 5.9 days after the operation (4 to 12 days), the average hospital stay was 7.2 days (5 to 13 days). Eleven immediate complications were observed (13.6%). The second group of 30 patients fed orally the day after the intervention included 7 women and 23 men. The average time from trauma to operation was 2.2 days (0 to 7 days), the average hospital stay was 2.5 days (2 to 3 days). One complication was observed (3.3%).


CONCLUSIONS
Immediate oral feeding the day after the operation for simple closed mandibular fractures provides certain comfort for the patient by avoiding the inconveniences of nasogastric feeding tubes without increasing the rate of postoperative complications such as disunion, delayed healing or infection. The hospital stay is significant shortened, enabling a real cost savings.
El Khatib
K
K
Hôpital Général, CHU de Dijon, 3, rue du Faubourg Raines, 21033 Dijon, France. drkelk21@hotmail.com
Gradel
J
J
Danino
A
A
Mouaffak
M
M
Malka
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008337:Mandibular Fractures / Q000145:classification / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology