title: Comparison of intraoral and extraoral approaches to mandibular angle fracture repair with cost implications.
abstract: OBJECTIVE
  The objective of this study was to analyze outcomes of intraoral and extraoral approaches to mandibular angle fractures and provide cost estimates for comparison.
  
  
  METHODS
  A retrospective review from January 2005 to June 2013 was performed of patients who underwent open reduction internal fixation of mandibular angle fractures at a level I trauma center.
  
  
  METHODS
  Patients were treated by three surgical specialties: otolaryngology-head and neck surgery, oral and maxillofacial surgery, and plastic and reconstructive surgery. Inpatient and outpatient medical records were reviewed for pertinent data including age, gender, duration of follow-up, presence of other mandible fractures, surgical approach, surgical team, operative time, and postoperative complications.
  
  
  RESULTS
  Of the 155 patients with mandibular angle fractures, 74% underwent open reduction internal fixation through an intraoral approach, whereas 26% of patients were treated with an extraoral approach. The occurrence of any complication was 69.6% in the extraoral group and 39% in the intraoral group (P = 0.009). In propensity-weighted analysis, however, the occurrence of any complication was less frequent in intraoral cases but no longer statistically significant (odd ratio 0.28; 95% confidence interval, 0.08 to 1.02; P = 0.053). Operating room time was significantly shorter with the intraoral approach. We estimate that the intraoral approach directly saves at least $2,900 per case.
  
  
  CONCLUSIONS
  We recommend the use of an intraoral approach for the repair of mandibular angle fractures when clinically appropriate. This can result in a comparable rate of success, however, with significant cost savings to the health care system.
  
  
  METHODS
  4. Laryngoscope, 126:591-595, 2016.
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, U.S.A.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Hsueh
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, U.S.A.
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.affiliation: Department of Oral and Maxillofacial Surgery, Jacobi Medical Center, Bronx, New York, U.S.A.
authors.forename: I
authors.initials: I
authors.lastname: Tien Shaw
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, U.S.A.|Department of Otolaryngology, Jacobi Medical Center, Bronx, New York, U.S.A.
authors.forename: Howard D
authors.initials: HD
authors.lastname: Stupak
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000191:economics* / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D019248:Jaw Fixation Techniques / Q000191:economics* / Q000295:instrumentation; D016015:Logistic Models; D008297:Male; D008337:Mandibular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D016017:Odds Ratio; D057216:Propensity Score; D016016:Proportional Hazards Models; D011859:Radiography; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
keywords: Mandible fracture; cost; extraoral; intraoral