title: Mandible Fracture Complications and Infection: The Influence of Demographics and Modifiable Factors.
abstract: BACKGROUND
  Mandible fractures account for 36 to 70 percent of all facial fractures. Despite their high prevalence, the literature lacks a comprehensive review of demographics, fracture patterns, timing of management, antibiotic selection, and outcomes, particularly when evaluating pediatric versus adult patients. The authors aim to determine the complication and infection rates after surgical treatment of mandibular fractures and the bacterial isolates and antibiotic sensitivities from mandible infections after open reduction and internal fixation at their institution.
  
  
  METHODS
  Data were collected retrospectively for all mandible fractures treated at the authors' institution between 2003 and 2013. Patients were divided into pediatric (younger than 16 years) and adult (16 years or older) subgroups. Demographics, fracture location, fracture cause, comorbidities, antibiotic choice, and subsequent complications and infections were analyzed. Data were evaluated using appropriate statistical tests for each variable.
  
  
  RESULTS
  Three hundred ninety-five patients were evaluated. Demographics and fracture cause were similar to those reported in current literature. Of the 56 pediatric patients, complications occurred in 5.6 percent. Time from injury to operative intervention did not affect outcome. The complication rate was 17.5 percent and the infection rate was 9.4 percent in the adult subgroup. Time from injury to operative intervention, sex, and edentulism were not significant predictors of complication or infection. Tobacco use, number of fractures, number of fractures fixated, and surgical approach were predictors of complication and infection. Perioperative ampicillin-sulbactam had a significantly lower risk of infection.
  
  
  CONCLUSIONS
  Certain demographic and operative factors lead to significantly higher risks of complications after surgical management of mandibular fractures. Ampicillin-sulbactam provides effective antibiotic prophylaxis. Risk factor modification may improve outcomes.
  
  
  METHODS
  Risk, IV.
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Odom
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Snyder-Warwick
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008337:Mandibular Fractures / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents