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- Title
Comparison of intraoral and extraoral approaches to mandibular angle fracture repair with cost implications.
- Authors
Hsueh, Wayne D.; Schechter, Clyde B.; Tien Shaw, I; Stupak, Howard D.
- Abstract
<bold>Objectives/hypothesis: </bold>The objective of this study was to analyze outcomes of intraoral and extraoral approaches to mandibular angle fractures and provide cost estimates for comparison.<bold>Study Design: </bold>A retrospective review from January 2005 to June 2013 was performed of patients who underwent open reduction internal fixation of mandibular angle fractures at a level I trauma center.<bold>Methods: </bold>Patients were treated by three surgical specialties: otolaryngology-head and neck surgery, oral and maxillofacial surgery, and plastic and reconstructive surgery. Inpatient and outpatient medical records were reviewed for pertinent data including age, gender, duration of follow-up, presence of other mandible fractures, surgical approach, surgical team, operative time, and postoperative complications.<bold>Results: </bold>Of the 155 patients with mandibular angle fractures, 74% underwent open reduction internal fixation through an intraoral approach, whereas 26% of patients were treated with an extraoral approach. The occurrence of any complication was 69.6% in the extraoral group and 39% in the intraoral group (P = 0.009). In propensity-weighted analysis, however, the occurrence of any complication was less frequent in intraoral cases but no longer statistically significant (odd ratio 0.28; 95% confidence interval, 0.08 to 1.02; P = 0.053). Operating room time was significantly shorter with the intraoral approach. We estimate that the intraoral approach directly saves at least $2,900 per case.<bold>Conclusion: </bold>We recommend the use of an intraoral approach for the repair of mandibular angle fractures when clinically appropriate. This can result in a comparable rate of success, however, with significant cost savings to the health care system.<bold>Level Of Evidence: </bold>4. Laryngoscope, 126:591-595, 2016.
- Subjects
MANDIBULAR fractures; MEDICAL care costs; POSTOPERATIVE care; HEALTH outcome assessment; PLASTIC surgery; COMPARATIVE studies; COST effectiveness; ENDOSCOPY; FRACTURE fixation; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; NONPARAMETRIC statistics; ORTHOPEDIC implants; PROBABILITY theory; RESEARCH; LOGISTIC regression analysis; EVALUATION research; TREATMENT effectiveness; PROPORTIONAL hazards models; RETROSPECTIVE studies; TRAUMA severity indices; JAW fixation techniques; ODDS ratio; FRACTURE healing; EQUIPMENT &; supplies
- Publication
Laryngoscope, 2016, Vol 126, Issue 3, p591
- ISSN
0023-852X
- Publication type
journal article
- DOI
10.1002/lary.25405