title: Characterization and management of mandibular fractures: lessons learned from Iraq and Afghanistan.
abstract: Fractures of the mandible are among the most common facial injuries. Invasiveness of treatment should be determined by the extent of injury: degree of displacement, number of fractures, the patient's health status, and concomitant injuries. Complex, comminuted, and avulsive injuries frequently seen in combat will require coordination with multiple specialties to provide the best treatment. Stabilization treatment with arch bars or external fixators and splints is often desirable when fractures are highly comminuted or the soft tissue envelope is compromised by tissue loss or burns. In severe injuries, many times reconstruction will take several surgeries. Debridement of necrotic tissue and devascularized bone and skin grafting often are necessary before reconstruction. Microvascular or myocutaneous flaps should be considered with significant tissue loss and osteocutaneous flaps when large continuity defects are present. Most mandible fractures are repaired in a single operation. Those caused by explosives and high-velocity projectiles are more complex. Research should continue to focus on improving outcomes for these patients. Advances in tissue engineering, bone regeneration, and composite tissue allografting will have to continue if we hope to restore facial form and function for our combat wounded.
authors.affiliation: Dental and Trauma Research Division, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Building 3611, Fort Sam Houston, TX 78234-6315, USA. David.tucker@amedd.army.mil
authors.forename: David I
authors.initials: DI
authors.lastname: Tucker
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zachar
authors.forename: Rodney K
authors.initials: RK
authors.lastname: Chan
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hale
mesh_terms: D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D016267:External Fixators; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D005593:Fracture Fixation, Internal / Q000379:methods; D018460:Fractures, Comminuted / Q000601:surgery; D006801:Humans; D054542:Iraq War, 2003-2011; D004204:Joint Dislocations / Q000601:surgery; D008337:Mandibular Fractures / Q000601:surgery*; D009104:Multiple Trauma; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods; D017695:Soft Tissue Injuries / Q000601:surgery; D013524:Surgical Flaps / Q000637:transplantation; D014950:Wounds, Penetrating / Q000601:surgery*