T. Soleimani1, T. A. Evans1, S. I. Fernandez1, L. Spera2, R. Sood1, C. Klene1, B. L. Zarzaur2, S. S. Tholpady1 2Indiana University School Of Medicine,Department Of Surgery,Indianapolis, IN, USA 1Indiana University School Of Medicine,Division Of Plastic Surgery,Indianapolis, IN, USA
Introduction: The rate of cervical spine injury (CSI) among trauma patients with mandibular fractures has been reported to be between 0.8 and 11%. They are anatomically related as forces on the mandible have the ability to damage the posterior portion of the ring, or the cervical spine. Recognition of CSI is critical in the management of mandibular fractures as manipulation of the neck during fracture fixation has the potential to cause spinal cord damage. The current study was designed to identify risk factors associated with CSI in patients with mandibular fractures using the largest US trauma database.
Methods: The National Trauma Databank (NTDB) 2007-2010 was reviewed for patients with the ICD-9 diagnosis code for mandibular fractures. Due to anatomic differences, patients were divided into two groups: children (<18 years) and adults (≥18 years). In each age group, the association between demographics, mechanism of injury, and injury characteristics with CSI was evaluated using bivariate analysis and logistic regression.
Results: A total of 8,317 children (14%) and 50,711 adults (86%) were identified. The rate of CSI in children was significantly lower than adults (3.5% vs 7.3%). In both age groups, the most frequent type of mandibular fracture was comminuted fractures (35.4% and 34.5% of children and adults respectively) followed by symphyseal (18.1%, 15.7%), body (13.2%, 15.3%), and condylar (16.6%, 11.3%) fractures. Using logistic regression different predictors of CSI were determined for adults and children; however, increased age, lower Glasgow Coma Score (GCS), thoracic injury (OR= children: 2.5, adults: 2.3), and motor vehicle accident (OR=3.0 and 4.0) or firearm (OR=9.5 and 3.0) mechanisms were predictive of CSI in both groups. In children, condylar (OR=0.5) or multiple mandibular (OR=0.7) fractures were inversely correlated with CSI. In adults, female gender (OR=1.1), mandibular body fracture (OR=1.2), and concomitant upper extremity injury (OR=1.4) predicted higher probability of CSI; multiple mandibular fracture (OR=0.8), concomitant abdominopelvic injury (OR=0.9), and concomitant lower extremity injury (0.8) were inversely correlated with CSI.
Conclusion: The results of this study demonstrate the demographics, mechanistic, and injury patterns most significantly associated with CSI in the adult and pediatric populations. Increased age, lower GCS, thoracic injury, and MVA or firearm mechanisms were associated with CSI in both groups. In adults, CSI was associated with female gender, mandibular body fracture, and concomitant upper extremity injury. The inverse correlation between multiple mandibular fracture with CSI could indicate that in multiple fractures the energy gets dissipated in the mandible instead of getting transmitted into the cervical spine. In order to prevent morbidity from CSI, these factors should be considered while evaluating patients with mandibular fractures.