Abstract
Background: Mandibular fracture fixation is commonly evaluated by radiographic union and occlusal stability, yet many patients experience prolonged limitations in jaw movement, chewing, and dietary intake. Functional recovery is shaped by fracture characteristics, fixation strategy, and post-treatment rehabilitation, but prospective evidence from South Asian tertiary care settings remains limited.
Objective: To prospectively track jaw mobility, chewing function, and nutritional status after mandibular fracture fixation, and to determine early predictors of delayed functional recovery in patients treated at a tertiary hospital in Punjab, Pakistan.
Methods: A prospective observational cohort study was conducted in adults and late adolescents (≥16 years) with radiographically confirmed mandibular fractures managed by open reduction and internal fixation (ORIF), closed reduction with maxillomandibular fixation (MMF), or combined approaches, according to routine clinical indications. Patients were followed at 2, 6, and 12 weeks post-treatment. Jaw mobility was measured using maximal interincisal opening (MIO) and mandibular excursions (lateral and protrusive). Chewing function was assessed using a structured patient-reported chewing difficulty scale and pain during mastication using a visual analog scale. Nutritional status was monitored through weight/BMI and 24-hour dietary recall; early postoperative weight loss was calculated relative to baseline. Physiotherapy was prescribed for all patients and compliance was categorized as high, moderate, or low using self-report supported by attendance records. Multivariable regression was applied to identify predictors of delayed functional recovery at 12 weeks (defined as persistently reduced jaw mobility and impaired chewing).
Results: Ninety-six patients were enrolled; 90 completed 12-week follow-up and were analyzed. The cohort was predominantly male (75.6%), with road traffic accidents as the leading cause of injury (56.7%). Mean MIO improved steadily from 24.1 ± 6.2 mm at 2 weeks to 33.4 ± 5.8 mm at 6 weeks and 41.2 ± 6.0 mm at 12 weeks. Functional recovery was slower in fractures involving the condyle and angle compared with parasymphysis/body injuries. Patients managed with ORIF demonstrated earlier gains in jaw mobility and chewing function than those treated with MMF, although group differences narrowed by 12 weeks. Chewing difficulty was common early (moderate–severe limitation in 71.1% at 2 weeks) and decreased markedly by 12 weeks (11.1%). Nutritional compromise was most pronounced in the early period, with mean weight change of −3.8 ± 1.4 kg at 2 weeks, improving to −1.1 ± 0.9 kg at 12 weeks. Physiotherapy adherence showed a clear dose–response relationship with recovery; high-compliance patients demonstrated consistently higher MIO and faster improvement in chewing scores. On multivariable analysis, condylar involvement, MMF duration >4 weeks, low physiotherapy compliance, and early postoperative weight loss >5% independently predicted delayed functional recovery at 12 weeks.
Conclusion: Functional recovery after mandibular fracture fixation is not uniform and is strongly influenced by modifiable factors. Early physiotherapy adherence and prevention of significant early weight loss are key targets for improving jaw mobility and chewing outcomes, particularly in patients with condylar fractures or prolonged immobilization. Integrating structured functional assessment, rehabilitation counseling, and nutritional support into routine follow-up may reduce delayed recovery in tertiary care trauma settings in Pakistan.