Algorithm for head computed tomography imaging in patients with mandible fractures.

PURPOSE: Trauma to the mandible can potentially increase our predictive accuracy for intracranial injuries (ICIs) because of the mandible's strength, anatomic proximity, and direct connection to the skull base. Our goals were to: 1) investigate the association of mandible fractures with traumatic brain injury (TBI) and intracranial lesions (ICLs); and 2) determine predictors of ICIs in a level 1 Canadian trauma center with distinct patient demographics and fracture etiologies.

PATIENTS AND METHODS: A retrospective chart review was performed of medical records of mandible-fracture patients treated at our institution from 1997 to 2003. Patients who had undergone postinjury computed tomography (CT) of the head with a minimum of 4 weeks' follow-up were considered eligible. Data collected included patient and fracture characteristics, neurologic evaluation, and the presence of concomitant injuries.

RESULTS: One hundred eighty-one patients were reviewed, of whom 86 were found eligible, with demographics representative of an urban-trauma population. The incidence of TBI was 68.6%, and of ICLs, 27%. Logistic regression identified alcohol (odds ratio [OR], 3.97), concomitant facial fracture (OR, 2.77), and other systemic injury (OR, 2.59) as independent predictors of an ICI in mandibular fracture patients. Importantly, ICIs were observed in 19% of mandible-fracture patients, satisfying the criteria for mild TBI, and in 17% of patients without any evidence of TBI.

CONCLUSIONS: Some authors have advocated treating mandible fractures on an outpatient basis, with a focused workup. Our results of significant concomitant ICI in mandible-fracture patients, conversely, suggest that such management may inadvertently result in the oversight of potentially life-threatening injuries. Thus, we recommend mandatory intracranial CT imaging if the patient's neurologic status at time of injury is unknown or meets the criteria of TBI, or if positive predictors for ICL are present.