Presentation and Management of Ballistic Mandibular Fractures: A Single Institution Experience

Introduction: Ballistic mandibular fractures represent a complex subset of maxillofacial trauma, producing wider zones of injury, tissue loss, and greater bony comminution than blunt mechanisms. Despite advances in surgical technique, data on the presentation, management, and complications of these injuries in a civilian urban setting remain limited. This study characterizes management and complications of ballistic mandibular fractures at a single urban Level I trauma center. Methods: An IRB-approved retrospective review was conducted of patients evaluated for ballistic mandibular fractures between July 2018 and August 2023. Demographic data, injury characteristics, treatment modality, and postoperative complications were recorded. Univariate and multivariate logistic regressions were performed to identify predictors of any complication and infection. Results: Ninety patients met inclusion criteria. The cohort was predominantly young (mean age 29.3 ± 13.2 years) and male (82.2%), with the majority of injuries resulting from assault (91.1%). Nearly all patients required admission (95.6%), with a mean length of stay of 17.6 days. Upon presentation, 75.6% required urgent intubation and 44.4% had significant facial hemorrhage. Forty percent had concurrent ballistic injuries to other craniofacial structures, and 52.2% sustained injuries to non-head-and-neck structures. Surgical management was required in 74.4% of patients, with a median time to definitive fixation of 8 days (IQR 3-12). Post-operative complications occurred in 20.9% of operative patients, most commonly infection (42.9% of complications), plate exposure (21.4%), and malunion or nonunion (21.4%). No independent predictors of complication or infection were identified on Firth’s regression analysis. Conclusions: Ballistic mandibular fractures in the civilian setting frequently present in the context of multiple concurrent injuries, requiring urgent multidisciplinary intervention. Despite complex injury profiles, timely definitive fixation was achievable, and concurrent injuries did not independently delay surgical management. No modifiable risk factors for postoperative infection or complication were identified.