Application of the Mandible Injury Severity Score to Pediatric Mandibular Fractures.
OBJECTIVE
The Mandible Injury Severity Score (MISS) has been used to evaluate adult mandibular fractures. The purpose of this study was to evaluate the MISS in a cohort of pediatric patients.


METHODS
This was a retrospective study of pediatric patients treated for mandibular fractures over a 20-year period. Patients were included if they had computed tomographic imaging available for review and had at least 1 post-treatment visit. The primary predictor variable was the MISS. Secondary predictors were demographic and injury-associated factors. The outcome was treatment-associated complications. Descriptive, bivariate, and multiple logistic regression statistics were computed.


RESULTS
One hundred sixteen patients with mandibular fractures were identified; 73 (62.9%) met the inclusion criteria. The sample's mean age was 8.5 ± 4.1 years; 44% were girls. Motor vehicle collisions (60%) and falls (15.1%) were the most common mechanisms. More than 50% of patients had an extra-mandibular injury. The mean MISS was 13.5 ± 7.8. Forty-five percent of the sample underwent open reduction and internal fixation. Complications were noted in 20.5% of patients, of which malocclusion was the most common (8.2%). Increasing MISS was associated with complications (P < .001). After controlling for the effects of age, mechanism, cervical spine and skull base injuries, and treatment, patients with an MISS of at least 14 were significantly more likely to have a complication (odds ratio = 4.0; 95% confidence interval, 1.05-15.0; P = .04).


CONCLUSIONS
In pediatric patients with mandibular fractures, increased severity of injury is associated with complications, even after controlling for the effects of multiple confounders, including open treatment.
Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Edward W
EW
Swanson
Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Srinivas M
SM
Susarla
MD and PhD Student, The Johns Hopkins University School of Medicine, Baltimore, MD.
Ali
A
Ghasemzadeh
Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Gerhard S
GS
Mundinger
Associate Professor, Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Richard J
RJ
Redett
Associate Professor, Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Anthony P
AP
Tufaro
Distinguished Service Professor of Surgery, Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Paul N
PN
Manson
Associate Professor, Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: adorafs1@jhmi.edu.
Amir H
AH
Dorafshar
D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D000367:Age Factors; D002574:Cervical Vertebrae / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D008310:Malocclusion / Q000209:etiology; D008337:Mandibular Fractures / Q000145:classification*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications; D016103:Spinal Fractures / Q000150:complications; D013705:Temporomandibular Joint Disorders / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods