Utility of Post-reduction Radiographic Analysis of Mandible Fractures

Objectives: Recognize that immediate post-reduction films: 1) Have a significant associated cost; 2) Do not alter management. Methods: A retrospective review of the medical record was performed on patients with mandible fractures operated on by the otolaryngology-head and neck surgery service between November 1, 2010, and November 30, 2012, at a level 1 county hospital. The post-operative imaging modalities were determined as well as if any changes in care were initiated by that image. Those patients who did have repeat imaging were evaluated to determine what led to the second image and what action was taken. Results: Fifty-seven patients met inclusion criteria. Fifty-five patients (96.5%) had a post-reduction image with 45 (79.0%) having a computed tomography (CT; $1,965) and 10 (17.5%) having a Panorex ($282). No immediate intervention was performed. Eleven patients (19.3%) had a second post-operative image with 4 (36.4%) receiving at least 1 panorex and 8 (72.7%) receiving at least one CT. Of these 11 patients, 8 (72.7%) underwent an intervention based on the imaging. Analysis showed imaging significantly affected the management of the second group of 11 but did not affect the first group of 55 (p=0.0000). Conclusions: In this study, 96.5% of patients received postoperative imaging at a cost of $91,245 with no change in management. This supports the conclusion that routine post-reduction imaging does not alter the immediate clinical course and should be reserved for those patients who have a postoperative clinical finding or complaint.