Comparison of intraoral and extraoral approaches to mandibular angle fracture repair with cost implications

Objectives/Hypothesis The objective of this study was to analyze outcomes of intraoral and extraoral approaches to mandibular angle fractures and provide cost estimates for comparison. Study Design 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. Methods 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. Results 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. Conclusion 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. Level of Evidence 4.