37. Impact Of Surgical Techniques and Patient Factors On Postoperative Outcomes in Mandibular Angle Fractures

PURPOSE: Mandibular angle fractures present significant challenges in maxillofacial surgery due to their complexity and the potential for postoperative complications, which can markedly affect patient outcomes. The choice of surgical approach, including the decision between intraoral versus retromandibular incisions, plays a critical role in managing these fractures. This study seeks to elucidate the impact of these surgical techniques alongside patient-specific factors such as demographics and pre-existing conditions on the incidence of complications. This research aims to enhance surgical decision-making and ultimately improve patient recovery and quality of life in mandibular fracture management by pinpointing the key factors that contribute to adverse outcomes. METHODS: In this retrospective study, we analyzed 116 cases from an IRB-approved database of patients with mandibular angle fractures managed by ORIF from 2018 to 2023. Using SPSS 27.0, we applied multivariate logistic regression to identify factors influencing postoperative complications stratified by infection, return to operating room (RTOR), and third molar extractions. The models comprised age, BMI, smoking status, presence of caries, fracture type, incision method, and third molar extraction during ORIF as predictors. RESULTS: The median age and BMI at the time of surgery were 31.7 years (Interquartile range [IQR] = 23.4-46.3) and 24.4 kg/m2 (IQR = 21.9-27.8), respectively. Multivariate analysis showed that retromandibular incisions significantly increased postoperative complication risks by 11.2 fold (P = 0.015) and combined approaches by 3.6 fold (P = 0.030) compared to intraoral incisions. The transparotid approach significantly influenced complications univariately (P = 0.013) but did not hold in multivariate analysis (P = 0.387), with trocar use showing a marginal increase in risk (P = 0.080). Isolated angle fractures decreased complication likelihood (OR = 0.173; P = 0.016). Age, BMI, smoking, and third molar extraction during surgery were not significant predictors of complications. There were no significant predictors for infection and RTOR rates in the multivariate model; however, older age and avoiding third molar extraction during ORIF suggested trends towards increased infection risk (P = 0.053) and decreased RTOR rates (P = 0.078), respectively. Incision type did not significantly affect post-surgery third molar extraction rates. Models for complications, infections, RTOR, and post-surgery third molar extractions accurately classified 82.1%, 94.7%, 93.8%, and 94.9% of cases, respectively. CONCLUSION: Our findings demonstrate that the choice of surgical incision type significantly impacts postoperative complication rates in mandibular angle fracture repairs. Specifically, retromandibular incisions were associated with a markedly increased risk of complications compared to intraoral approaches, with combined approaches also showing an elevated risk. These results emphasize the importance of selecting a tailored surgical approach based on both fracture characteristics and patient-specific factors to optimize outcomes and minimize risks. Further studies are recommended to refine our understanding of these relationships and develop evidence-based guidelines to support clinical decision-making in mandibular fracture management.