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Non-Tobacco Nicotine Dependence Increases Risk Of Osteomyelitis And Hardware Infection In Mandibular Fractures
Matthew Q. Dao, BS1, Emma M. Lascar, BS
2, Sheuli Chowdhury, MD
2, Perri S. Vingan, MD
2, Jasmin Wilson, MD
2, Nissim Hazkour, MD
2, Sabrina Shih, MD
2, Eloise W. Stanton, MD
3, Peter W. Henderson, MD, MBA
2, Peter J. Taub, MD
2.
1John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA,
2Division of Plastic and Maxillofacial Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA,
3Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
PURPOSE: With the rise of e-cigarettes and smokeless nicotine delivery, patients may present for maxillofacial surgery with exclusive use of tobacco-free nicotine products. While tobacco exposure is a known risk factor for impaired healing and infection, the independent impact of non-tobacco nicotine dependence (NTND) in mandibular fracture repair is poorly defined. The present study evaluated whether NTND predisposes patients to worse outcomes following interdental fixation for mandibular fracture.
METHODS: The TriNetX Research Network was queried for patients undergoing open reduction with interdental fixation for mandibular fracture. Patients with NTND, excluding those with tobacco use, were compared to nicotine-free individuals. Propensity score matching (1:1) was performed for demographics, socioeconomic status, body mass index, and comorbidities. Primary outcomes at one year included osteomyelitis, infected hardware, facial abscess, and nonunion. Secondary outcomes included periodontitis, dental caries, orofacial pain, and onset of opioid use disorder. Risk ratios (RR) were calculated from absolute risk percentages, with significance set at p<0.05.
RESULTS: Of 2,235 NTND and 12,725 nicotine-free patients, 2,124 were matched per cohort. NTND patients had higher risk of osteomyelitis (4.3% vs 2.5%, RR 1.73, p=0.001), hardware infection (3.0% vs 1.9%, RR 1.60, p=0.017), facial abscess (3.9% vs 2.4%, RR 1.61, p=0.007), orofacial pain (3.8% vs 2.1%, RR 1.80, p=0.002), and onset of opioid use disorder (1.3% vs 0.6%, RR 2.08, p=0.027).
CONCLUSION: NTND is associated with elevated risk of infection, pain, and opioid use disorder after mandibular fracture fixation. These findings reinforce the importance of nicotine cessation counseling, regardless of source, in surgical planning.
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