Delayed diagnosis of traumatic cervical subluxation in patients with mandibular fractures: a 5-year retrospective study.
BACKGROUND
Mandibular bone fracture associated with traumatic cervical subluxation is a rare injury. The diagnosis of a traumatic cervical subluxation is more easily delayed than other conditions in patients with mandibular bone fractures. The aim of this study is to investigate the incidence of traumatic cervical subluxation associated with mandibular bone fractures.


METHODS
This is a retrospective cohort study of 653 consecutive emergency department patients with mandibular bone fractures investigated for evidence of concomitant traumatic cervical subluxation.


RESULTS
This study reports on 7 patients (1.07%) with a diagnosis of traumatic cervical subluxation from a cohort of 653 with mandibular bone fractures as a result of motor vehicle accidents. Two of seven patients had their diagnosis made while in the emergency room, thus, 71.43% of these injuries were discovered on studies done up to 10 days after the trauma, including after surgical correction of the mandibular bone fracture.


CONCLUSIONS
The importance of a thorough initial examination (both physical and radiologic) and suspicion of traumatic cervical subluxation in patients with mandibular bone fractures is worth emphasizing as delayed diagnosis and management could result in permanent neurologic injury. We suggest dynamic flexion-extension cervical radiographs and thin-slice computerized tomography scans in patients with mandibular fractures routine as an important and routine practice protocol.
Tu
Po-Hsun
PH
Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical College and University, Linkou, Taiwan.
Liu
Zhuo-Hao
ZH
Yang
Tao-Chieh
TC
Lee
Shih-Tseng
ST
Chen
Jyi-Feng
JF
D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008337:Mandibular Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult