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Original Investigation |

Barriers to Repair in Maxillofacial Trauma

J. Paul Radabaugh, MD1; Paul Zhang, MD, MPH1; Duane Wang, MD2; Philip L. Y. Lin, DDS, MD3; Jared Shelton, DMD, MD3; James Y. Liau, MD2; Larry L. Cunningham Jr, DDS, MD3; Thomas J. Gal, MD, MPH1
[+] Author Affiliations
1Department of Otolaryngology, Head and Neck Surgery, University of Kentucky College of Medicine, Lexington
2Division of Plastic Surgery, Department of Surgery, University of Kentucky College of Medicine, Kentucky Clinic, Lexington
3Department of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry Lexington
JAMA Facial Plast Surg. 2016;18(3):177-182. doi:10.1001/jamafacial.2015.2101.
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Importance  Multiple factors can be associated with the delayed repair of maxillofacial injuries that may be associated with increased morbidity.

Objective  To assess factors affecting timing of repair and barriers which may exist in the management of maxillofacial trauma.

Design, Setting, and Participants  This retrospective cohort study at a tertiary care facility used the Current Procedural Terminology coding to identify adult patients undergoing operative repair of maxillofacial injuries between January 2010 and December 2013. Demographic information, presence and severity of concomitant injuries, as well as fracture-specific data including fracture type(s), mechanism of injury, and documented complications were recorded. Identifiable delays for medical, logistical, or other reasons were also documented. Multivariate regression modeling was used to determine factors associated with increased time to repair. A comparative analysis was used to identify association between complications and time to operative repair.

Main Outcomes and Measures  Time to operative repair from date of presentation; association of known operative delay and perioperative complications.

Results  Overall, 780 patients were included in the study. Of patients meeting inclusion criteria, mean (SD) age was 36.7 (14.2) years (range, 18-88 years), and 616 patients (79%) were male. Average time to repair was 6.5 days (range, 0-43 days), and 138 patients (17.7%) were observed to have a documented reason for delay for medical reasons (n = 62 [44.9%]), operating room logistical factors (n = 17 [12.3%]), or other reasons (n = 59 patients [42.8%]) either as a function of delayed patient presentation or failure of patients to make scheduled appointments or operations. Injury severity score (ρ = 0.45; P < .001), concurrent injuries (P < .001), decreased Glasgow Coma Scale (P < .001) and inpatient status at time of surgery (P < .001), were associated with increased time to repair. The observed complication rate was 13.6%. There was no statistically significant association between known operative delay and development of complications (χ21 = 2.92; P = .08).

Conclusions and Relevance  Management of maxillofacial trauma appears to occur in a timely manner. Patient injury severity appears to have the greatest effect on timing of repair. While delays in operative repair may be unavoidable in certain circumstances, streamlining and managing causes of known delay may help improve and expedite patient care.

Level of Evidence  3.

Figures in this Article

Figures

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Figure 1.
Distribution of Mechanisms of Injury
Graphic Jump Location
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Figure 2.
Distribution of Classifications of Fracture Type

NOE indicates nasoorbitoethmoid.

Graphic Jump Location

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