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Original Investigation |

Incidence of Concussion in Patients With Isolated Mandible Fractures

Lindsay Sobin, MD1,2; Robert Kopp, MD1; Ronald Walsh, NP1; Robert M. Kellman, MD1; Tucker Harris, MD3
[+] Author Affiliations
1Department of Otolaryngology, State University of New York Upstate Medical Center, Syracuse
2currently with the Department of Otolaryngology, Boston Children’s Hospital, Boston, Massachusetts
3currently in private practice in Horseheads, New York
JAMA Facial Plast Surg. 2016;18(1):15-18. doi:10.1001/jamafacial.2015.1339.
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Importance  This study examines the association between isolated mandible fractures and mild traumatic brain injury (mTBI).

Objective  To determine the rates of mTBI in patients who have sustained isolated mandible fractures.

Design, Setting, and Participants  A prospective study was conducted among patients who sustained isolated mandible fractures within 24 hours of presentation. Patients were administered the Military Acute Concussion Evaluation (MACE). Recorded data included demographics, time since injury, use of alcohol or illicit drugs, nonfacial pain, and mechanism of injury. All patients were evaluated in the emergency department of a level I trauma center between June 20, 2013, and June 20, 2014. In addition, discharge data from the Nationwide Inpatient Sample database was analyzed to identify current rates of patients with a diagnosis of both mandible fractures and concussions.

Main Outcomes and Measures  Rates of concussion. Patients with a MACE score of less than 25 were considered to have mTBI.

Results  Sixteen patients met the study criteria over a 1-year period. Fourteen patients (88%) were male, and mean age was 27.5 years. The mean time since injury was 11.25 hours (range, 3-21 hours). The mechanism of injury was assault in 12 patients (75%), sports in 2 patients (13%), all-terrain vehicle crash in 1 patient (6%), and biking in 1 patient (6%). Eight patients (50%) admitted to the use of alcohol, and none reported the use of illicit drugs. Eleven patients (69%) reported loss of consciousness. Twelve patients (75%) met criteria for concussion according to the MACE. Among these 12 patients, 7 (58%) admitted to the use of alcohol at the time of injury. There was no relationship between the rates of concussion and the use of alcohol.

Conclusions and Relevance  Mandible fractures are often sustained after high-force impacts during altercations between men. In our study, a 75% (12 of 16) rate of concussions associated with isolated mandible fractures was identified. Patients with isolated mandible fractures may benefit from being screened for concussion and referred to a concussion clinic.

Level of Evidence  4.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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