Traumatic Brain Injury in Patients With Mandibular Fractures.

Abstract

Background: Traumatic brain injury (TBI) associated with facial fractures is a major public health concern worldwide. The rate of TBI in patients with mandibular fractures ranges from 21.3% to 39.6%. However, the risk factors for TBI in patients with mandibular fractures remain unknown. Our study evaluates these risk factors.

Methods: We retrospectively reviewed patients who presented with traumatic mandibular fractures in 2018 and 2019. Excluded were patients with no documentation of Glasgow Coma Scale. Our primary outcomes were: (1) prevalence of concomitant TBI on presentation defined as having a positive head computed tomography scan (hemorrhage, parenchymal contusion, diffuse axonal injury), or a negative scan with Glasgow Coma Scale < 15 or any neurologic symptom/sign; (2) prevalence of posttraumatic neurologic symptoms assessed at ≥4 weeks after injury. The mandibular injury severity score (MISS) was calculated for all patients. Bivariate analysis and multivariable logistic regression were performed.

Results: Of 390 patients with mandibular fractures, 165 (42.3%) had concomitant TBI on presentation. Of those, 61% (n = 101) had mild TBI, 12% (n = 20) had moderate TBI, and 27% (n = 44) had severe TBI. Almost half of the mandibular fractures were due to assault (182 [47%]). Older age at injury and the presence of other facial fractures were associated with significantly greater odds of TBI on presentation (adjusted odds ratio 95% confidence interval [CI] 1.016 [1.001-1.032], P = 0.040; 2.457 [1.551-3.891], P < 0.001). Of 195 patients who were assessed at ≥4 weeks after injury, 99 (51%) had neurologic symptoms, most commonly facial numbness (74 [38%]). Mandibular body fracture and a high MISS were associated with significantly greater odds of having neurologic sequelae at ≥4 weeks after injury (adjusted odds ratio [95% CI] 3.12 [1.31-7.50], 1.12 [1.04-1.20]).

Conclusions: Older patients and those with mandibular body fractures and a high MISS may benefit from TBI screening and close longitudinal follow-up to identify and manage neurologic sequelae.