Comparing the Infection Rates of Strut Versus Straight Plates in Sagittal Split Osteotomies.

Abstract

Background: Sagittal split osteotomies can be rigidly fixated through various methods. Unfortunately, infection remains a common postoperative complication.

Purpose: The purpose was to estimate postoperative infection rates between strut and straight plates for internal fixation of sagittal split osteotomies.

Study design, setting, sample: We implemented a retrospective cohort study and included a consecutive series of patients with sagittal split osteotomies performed at the University of Nebraska Medical Center. The cases were performed by a single surgeon with a chief as resident surgeon. Exclusion criteria included any patient with unilateral surgery, mandibular midline osteotomy, previous mandible reconstruction, distraction osteogenesis, previous facial trauma history, and less than 12 weeks of follow-up.

Predictor variable: Primary predictor variable was plate type (strut vs straight). The choice of plate was not based on the surgical plan.

Main outcome variable(s): The primary outcome variable was postoperative infection. This was defined as purulent discharge, incision and drainage, or prescription of antibiotics. Secondary outcomes include hardware removal and neurosensory function.

Covariates: Covariates included demographics, smoking, alcohol and drug use, single/double jaw, advancement/setback, length of movement, and perioperative third molar extraction.

Analyses: Fisher's exact test, χ² test, and Student's t test were computed to measure bivariate association. The relative risks (RRs) and their 95% CIs were reported. P values < .05 were considered statistically significant.

Results: The sample comprised 112 subjects: 51 (45.5%) straight plate and 61 (54.5%) strut plate. There were 32 (62.7%) women in the straight plate group, mean age 25.55 ± 13.34 years and 39 women (63.9%) in the strut plate group, mean age 29.02 ± 11.97 years. Postoperative infection was the most common reason for plate removal (n = 10). Strut plates, relative to straight plates, were associated with a 23% increase (RR 1.23, 95%, CI 0.47 to 2.16, P < .7) in infections, a 25% increase (RR 1.25, 95%, CI 0.45 to 2.27, P < .5) in hardware removal, and a 17% increase (RR 1.17, 95% CI 0.33 to 2.44, P < .7) in postoperative neurosensory disturbance at 3 months for sagittal split osteotomies.

Conclusions and relevance: The choice of internal fixation plate, strut versus straight, was not associated with postoperative infection, hardware removal, or postoperative neurosensory function deficit.