Impairment of wound healing after operative treatment of mandibular fractures, and the influence of dexamethasone.
Our aim was to clarify the incidence of impaired wound healing after open reduction and ostheosynthesis of mandibular fractures, and to find out whether the use of dexamethasone during the operation increased the risk. Patients were drawn from a larger group of healthy adult dentate patients who had participated in a single-blind, randomised study, the aim of which was to clarify the benefits of operative dexamethasone after treatment of facial fractures. The present analysis comprised 41 patients who had had open reduction and fixation of mandibular fractures with titanium miniplates and monocortical screws through one or 2 intraoral approaches. The outcome variable was impaired healing of the wound. The primary predictive variable was the perioperative use of dexamethasone; other potential predictive variables were age, sex, smoking habit, type of fracture, delay in treatment, and duration of operation. Wound healing was impaired in 13/41 patients (32%) (13/53 of all fractures). The incidence among patients who were given dexamethasone and those who were not did not differ significantly. Only age over 25 was significantly associated with delayed healing (p=0.02). The use of dexamethasone 30 mg perioperatively did not significantly increase the risk of impaired wound healing in healthy patients with clinically uninfected mandibular fractures fixed with titanium miniplates through an intraoral approach. Older age is a significant predictor of impaired healing, which emphasises the importance of thorough anti-infective care in these patients during and after the operation.
Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland. Electronic address: johanna.snall@helsinki.fi.
Johanna
J
Snäll
Eeva
E
Kormi
Christian
C
Lindqvist
Anna Liisa
AL
Suominen
Karri
K
Mesimäki
Jyrki
J
Törnwall
Hanna
H
Thorén
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001860:Bone Plates; D001863:Bone Screws; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing / Q000187:drug effects*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000188:drug therapy / Q000601:surgery*; D008875:Middle Aged; D061646:Operative Time; D011292:Premedication; D012307:Risk Factors; D012737:Sex Factors; D016037:Single-Blind Method; D012907:Smoking; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone
Dexamethasone; Fracture; Glucocorticoid; Healing; Mandibular; Wound