C-REACTIVE PROTEIN AS AN INDICATOR TO DETERMINE THE TREATMENT OUTCOME IN MAXILLOFACIAL FRACTURES

Purpose: To evaluate levels of CRP with severity of maxillofacial trauma and to correlate it with the overall prognosis of the maxillofacial fractures after standardized surgical treatment. A prospective study on C- reactive prote Material And Methods: in was conducted on subjects presenting with maxillofacial trauma reporting to the OPD-Department of Oral and Maxillofacial surgery, ABSMIDS for a period of 2 years. Patients with head injury, poly trauma, hepatocellular disease, cardiovascular disease, pneumonia or if the patient had a recent history of surgery in the past 1 month were excluded from the study after a detailed case history and clinical examination. A total of 119 subjects were included in the study and CRP levels were assessed preoperatively at the time of admission, post operatively after twenty four hours and on postoperative day four. Results: 106 patients included in the study reported within forty-eight hours of trauma and the levels of C- reactive protein in the body increased with the time elapsed since trauma, with the highest values at around forty-eight hours of trauma and lowest values when the patient reported immediately post trauma. 13 patients who reported after 48 hours of trauma were assessed separately. The fractures involving mandible showed signicantly higher values of pre-operative CRP as compared to ZMC fractures (p< 0.001). On comparing the preoperative CRP values of fractures based on open (N=58; mean CRP- 22.75mg/L) or closed fractures (N=48; mean CRP -11.83), signicant difference was found. Also on comparing between the single bone, two bone and multiple facial fractures statistically signicant difference (p<0.0001, p<0.002, p< 0.0001 respectively) with a higher value on open fractures was seen. Irrespective of the approach used for a closed fracture, postoperatively the CRP values remained signicantly lower as compared to the open fractures (p<0.001). Postoperatively on day four when CRP values were recorded the values reduced drastically beginning to normalize and we got a certain curve for CRP in maxillofacial trauma patients. This curve remained constant in open and closed fractures as well, with open fractures having a steeper curve and a longer period for CRP to normalize. The fractures of the facial Conclusion: skeleton is prone to infections due to the high bacterial ora present in the oral cavity. Awareness of the natural CRP responses after fractures may help in conrming the normal healing pattern for various bones, which can help us plan the correct treatment sooner thereby preventing the prolonged usage of antibiotics.