Risk factors associated with short-term complications in mandibular fractures: the MANTRA study—a Maxillofacial Trainee Research Collaborative (MTReC)
Authors: Kent S. , Adatia A. , James P. , Bains K. , Henry A. , Blore C. , Dawoud B. , Kumar D. , Jefferies C. , Kyzas P. ,   MTReC Collaborators:, Sonigra D. , Botha E. , Ooi S. , Bosov M. , Fish E. , Lin Y. , Aslam-Pervez B. , Fletcher R. , Wright F. , Khan H. , Collins T. , Loke R. , Niraj L. , Dhanjal G. , Ghosh A. , Kaneria V. , McIntosh C. , Moksud M. , O Higgins C. , Taha A. , Thompson A. , Tow G. , Wege J. , Sidat F. , Sthankiya M. , Hughes D. , Ng S. , Patel H. , Smyth D. , Craddock C. , Douglas J. , Gordon C. , Iyer S. , Jefferies C. , Sexton P. , Taylor R. , Walshaw E. , Man C. , Sankey J. , Wilcock H. , Nijamudeen A. , Tabbenor O. , Davies A. , Henderson T. , Pigadas N. , Rupchandani R. , Zakai D. , Coll Y. , Dunphy B. , Gruber E. , Ko Y. , Kulkarni R. , Paul R. , Jetty K. , Exley R. , Pancholi R. , Horisk N. , Korobczuk A. , Chandran C. , Dalal A. , Shivam R. , Allison N. , Stonier G. , Dylgjeri F. , Rooney J. , Svoboda T. , Ahmed A. , Farooq S. , Turton N. , Clyde S. , Ritchie M. , Brandsma S. , Nazir H. , Mousa Y. , Choudhury S. , Crawley K. , Offen E. , Iqbal A. , Baniulyte G. , Pamma A. , Yaqoob O. , Britton D. , Sanapala C. , Hashem I. , Icel S. , Goodall A. , Uddin M. , Uddin M. , Aziz A. , Docherty C. , Huguet H. , Kelly M. , Thorley W. , Brar J. , Min A. , Pepper T. , Carr R. , Fahy E. , Geddes A. , Hennigan M. , Simpson C. , Cobb M. , Denholm K. , Neilson J. , Swansbury A. , Dickason A. , Scott R. , Wotherspoon E. , Johnston D. , Murphy D. , Alreefi M. , Althawadi N. , Howells R. , Miles S. , Saadya A. , Sawali J. , Suleiman A. , Olujide S. , Hannah A. 
Published: July 2022

Abstract
Introduction
Complications following mandibular fractures occur in 9–23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures.

Methods
The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome.

Results
Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation.

Discussion
We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications.