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Eighty-four patients met inclusion criteria and were grouped by day to repair. They found no difference in rate of infection and the only predictor was the history of substance abuse. They did reveal, however, a significantly greater rate of technical complications in the delayed group (P http://www.selleckchem.com/products/BEZ235.html pain, and malocclusion. The early group had no complications, whereas the delayed group had 10 (18.9%) patients with these problems. They did not look at the incidence of substance abuse for these groups separately. Moreover, the severity and complexity of fractures were not addressed for the two patient groups, which may have introduced a bias. They recommend an earlier repair of mandible fracture based on the greater incidence of these ��technical complications�� and stress the need to be even more vigilant when delay is unavoidable. Other studies have concluded that a delay in repair did not impact outcomes.1�C3 Czerwinski et al.1 performed a retrospective study of 177 patients and divided them into two groups, those repaired within 72 hours and those after 72 hours. They found no difference in outcomes but did note an association with infection and substance abuse (P http://www.selleckchem.com/products/byl719.html They found four studies that showed no difference in complication rate between early or delayed repair. There http://www.selleck.cn/products/gsk-j4-hcl.html were no retrospective studies, and the conclusion of the article was that there is no evidence to support either early or delayed repair. Table I illustrates the summary findings of each reference. Only one study showed a significant association with timing. Substance abuse included tobacco, alcohol, or other drug use. Complications included technical and/or infectious complications. Delay in surgical repair of mandible fractures may be unavoidable. It is not always due to significant associated injuries (cervical spine, intracranial injury, etc.). Compliance in this population is frequently unpredictable, and many patients may seek medical care only after a delay (particularly if their analgesics have been depleted). Ideally, a randomized study would allow an accurate comparison of outcomes but this is unlikely to be achieved. At present, there is no evidence confirming that immediate repair is necessary for better outcomes with mandible fractures. Delay in repair can be associated with technical challenges and complications. A more vigilant debridement, reduction, and fixation are all warranted. Delay up to 5 days after injury has not been shown to compromise outcomes in terms of bony union and occlusion. Substance abuse appears to be associated with a greater rate of infection.