title: Evaluation of surgical retreatment of mandibular fractures.
abstract: BACKGROUND
  Mandibular fractures are frequent, and treatment for these fractures involves rigid fixation. Complications can occur after treatment and may require a new surgical procedure; however, there are limited studies evaluating surgical retreatment.
  
  
  OBJECTIVE
  The purpose of this retrospective study was to evaluate the characteristics and the types of treatment carried out in patients requiring surgical retreatment of mandibular fractures.
  
  
  METHODS
  From all patients with mandibular fractures treated by rigid internal fixation at a trauma hospital during a 7-year-period, 20 patients (4.7% of the cases) required a second surgery.
  
  
  RESULTS
  The most common complaints were pain, infection with the presence of fistula, and abnormal mobility. There was a predominance of Staphylococcus aureus in the bacterial culture. The most frequent radiographic images were diffuse bone resorption, loosening of screws, and a visible fracture line. The diagnoses were nonunion in 10 (50%) cases, soft tissue infection associated with screw loosening or plate exposure in 7 (35%) cases, osteomyelitis in 2 (10%) cases, and malunion in 1 (5%) case. Seven cases of nonunion presented with fistula, and four of these patients had bone sequestration. The required procedures included new fixation in 6 (30%) patients, removal of bone sequestration and new fixation in 4 (20%) patients, surgical exploration and removal of fixation material in 7 (35%) patients, removal of bone sequestration in 2 (10%) patients, and refracture in 1 (5%) patient.
  
  
  CONCLUSIONS
  It was concluded that most cases requiring surgical retreatment of mandibular fractures comprised nonunion or soft tissue infection associated with screw loosening or plate exposure. Consequently, the main procedures needed were new fixation or surgical exploration with the removal of fixation material.
authors: Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil. yamamoto@usp.br
authors: Marcos Kazuo
authors: MK
authors: Yamamoto
authors: Ricardo Pimenta
authors: RP
authors: D'Avila
authors: João Gualberto de Cerqueira
authors: JG
authors: Luz
mesh_terms: D000293:Adolescent; D000328:Adult; D001862:Bone Resorption / Q000209:etiology; D002648:Child; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery; D004868:Equipment Failure; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017759:Fractures, Malunited / Q000209:etiology / Q000601:surgery; D005599:Fractures, Ununited / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000209:etiology / Q000601:surgery; D008337:Mandibular Fractures / Q000601:surgery*; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000209:etiology / Q000601:surgery; D013203:Staphylococcal Infections / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D055815:Young Adult