Assessment of Treatment Modalities for Mandibular Fracture in Patients with Compromised Pulmonary Function

Assessment of Treatment Modalities for Mandibular Fracture in Patients with Compromised Pulmonary Function | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Treatment Modalities for Mandibular Fracture in Patients with Compromised Pulmonary Function Chiedu Benz Ogboh, Samuel Gbenga Adetunji, Peter Esezobor Egbor, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7456482/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Mandibular fractures are among the most common facial injuries managed by oral and maxillofacial surgeons, with road traffic accidents as the leading cause in many developing countries. While Open Reduction and Internal Fixation (ORIF) and Closed Reduction with Maxillomandibular Fixation (MMF) are both effective treatment modalities, their differential impacts on pulmonary function remain understudied. The objective of the study was to compare the effects of ORIF and MMF on pulmonary function in patients with isolated mandibular fractures. Methods A randomised comparative longitudinal study was conducted among 66 patients with isolated mandibular fractures. Participants were equally assigned to Open Reduction and Internal Fixation (group 1) and Closed Reduction with Maxillomandibular Fixation (group 2) groups. Preoperative and postoperative pulmonary function tests were carried out at different intervals using standard protocols. Data were analysed using SPSS version 26 with significance set at p < 0.05. Results Both groups showed comparable baseline pulmonary function. However, group 2 patients experienced a significant decline in pulmonary parameters at 24 hours, 1 week, and 2 weeks postoperatively. Although recovery was observed by the 4th and 6th weeks, Forced Vital Capacity (FVC) remained lower in group 2, while FEV₁/FVC was significantly higher. One week after MMF removal, Peak Expiratory Flow Rate (PEFR) and FEV₁/FVC values rebounded significantly in the MMF (group 2). Conclusion Even though MMF remains a viable, low-cost option of managing mandibular fractures, ORIF is associated with less respiratory impairment and may be better suited for patients at risk of pulmonary complications. These findings also underscore the importance of individualised treatment planning. Mandibular fracture ORIF MMF Pulmonary function Spirometry Airway obstruction Maxillofacial trauma Background Mandibular fractures are among the most common facial skeletal injuries and account for a significant proportion of cases managed by Oral and Maxillofacial surgeons 1 . In many developing countries, road traffic accidents (RTAs) remain the leading cause of these injuries, largely due to the lack of strict enforcement of traffic regulations or the widespread disregard for existing laws 1 . Other notable causes include interpersonal assaults, gunshot wounds, contact sports, and industrial accidents 1 . Mandibular fractures rarely cause respiratory complications 2 . However, in uncommon cases, such as when the anterior attachment of the genioglossus muscle is disrupted 3 or in bilateral body fractures of the mandible (flail mandible), the tongue may displace posteriorly, leading to airway obstruction 2 . The standard treatment for mandibular fractures is Open Reduction and Internal Fixation (ORIF), which involves surgical exposure, anatomical reduction of the fracture, and stabilisation with plates and screws 4 . This technique, typically performed under general anaesthesia, allows for immediate mandibular function but requires specialised skills, instruments, and is cost-intensive 5 . In contrast, Closed Reduction with Maxillomandibular Fixation (MMF) remains in use in some low- and middle-income countries 1 , 6 , 7 . Closed reduction with maxillomandibular fixation (MMF) involves aligning mandibular fracture segments indirectly by establishing correct dental occlusion, without direct visualisation of the fracture sites 8 . According to Juniper and Awty 9 , the typical duration of immobilisation in mandibular fracture management ranges from 3 to 6 weeks. During immobilisation, the mouth is kept closed to minimise interfragmentary movement, thereby restricting full mandibular excursive function. Pulmonary Function Tests (PFTs ) such as Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV 1 ), Peak Expiratory Flow Rate (PEFR), Maximum Voluntary Ventilation (MVV), and their derivatives are important non-invasive measures used to evaluate lung performance. PFTs provide important information relating to the large and small airways, the pulmonary parenchyma and the size and integrity of the pulmonary capillary bed 10 . The tests have also become part of routine health examinations in respiratory, occupational, and sports medicine 11 . They have evolved from tools for physiologic study to clinical tools widely used in assessing respiratory status 11 . These parameters are especially crucial when planning surgical interventions in patients with potential airway compromise 12 . While both ORIF and MMF methods are effective in achieving bone union and restoring occlusion, their impact on pulmonary function has not been extensively studied. Therefore this study aimed to compare the effects of ORIF and MMF on pulmonary function among patients with mandibular fractures, thereby identifying the treatment modality more suitable for individuals with compromised pulmonary status. Materials and Methods The study design was a randomised comparative longitudinal study that compared the effects of ORIF and MMF on pulmonary function among patients with mandibular fractures. The study population comprised patients with clinical and radiological features of isolated mandibular fractures who presented to the study centres: Oral and Maxillofacial Surgery Clinic, University of Benin Teaching Hospital (UBTH), Benin City, Edo State. The study was conducted between February 2022 and December 2022. Ethical approval for this study was obtained. And written consent was signed by all eligible participants who participated in the study. Other inclusion criteria were absence of concomitant fracture in other parts of the body, patients with no missing anterior teeth (which could allow mouth breathing for the MMF group), patients with no history of obstructive or restrictive respiratory disease and whose preoperative pulmonary function tests were within the normal range, patients who tolerated mouth closure (MMF) for six weeks, American Society of Anesthesiologists physical status 1 (ASA 1) patients, and patients without any comorbidity that adversely affected the procedure. Patients with edentulous mandibular and/or maxillary arch(es) that affected the placement of MMF and those who declined the modality of treatment based on finance or preference were excluded. Similarly, patients with psychiatric illness/mental impairment, uncontrolled or poorly controlled seizures, patients with a history of head and neck cancer or radiotherapy, chronic smokers, alcoholics, pregnant or lactating patients and patients on oral contraceptives or/and anticoagulant therapy were all excluded from the study. The minimum sample size was calculated using the appropriate sample size formular 13 , with values from a previous study 14 . Thus, 66 participants were recruited for the study groups and were assigned into two equal groups of thirty-three (33) participants each, using a computer-based randomisation technique in GraghPad. Participants’ biodata, type of mandibular fracture, height, weight, Mandible Injury Severity Score (MISS) and any relevant medical history were taken, and information was recorded preoperatively. All patients were exposed to a posterior-anterior jaw view, oblique left and right lateral views of the mandible and the type of mandibular fracture was determined. The Mandible Injury Severity Score MISS was calculated for each participant, as described by Shetty et al 15 . The procedure for pulmonary function tests was explained to the participants and performed according to the American Thoracic Society and European Thoracic Society standards and recommendations. Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV 1 ), Peak Expiratory Flow Rate (PEFR), and the ratio of FEV 1 to FVC were measured for all participants just before treatment using a spirometer. Also, Maximum Voluntary Ventilation (MVV) was measured, and the ratios of MVV to predicted MVV (%MVV) and the MVV to body surface area (BSA) were calculated 1 . Predicted values of pulmonary function parameters (FVC [L], FEV 1 [L], FEV 1 /FVC [%], PEFR [L/s]) and MVV were determined using reference values for Nigerians 17 . The measured baseline/preoperative pulmonary function values from all patients were compared with the predicted values, and the result obtained (FEV 1 /FVC) was used to ensure that only participants whose FEV 1 /FVC value was > 80% and with a normal pulmonary function pattern were recruited/enrolled for the study 17 , 18 . Surgical procedures (ORIF or MMF) were carried for all participants by a team of surgeons. For the ORIF group (group 1), the fracture site was surgically exposed under general anaesthesia, and fracture segments were anatomically reduced and secured in place using 2.0mm titanium miniplates positioned to ensure stable alignment during healing as described by Singla et al 4 and Fathima et al 1 9 . For the MMF group (group 2), the procedures were performed under local anaesthesia (2% lignocaine in 1:100,000 adrenaline). The fractures were indirectly reduced and stabilised by mandibular-maxillary fixation (MMF) using tie wires. All participants in this group remained on MMF for a continuous period of six weeks, after which the fixation was carefully released, following clinical and radiographic confirmation of satisfactory bone healing and stability. Participants in both groups received appropriate standard postoperative care to promote healing, minimise complications, and ensure overall patient well-being. After the surgical procedures, the pulmonary function tests (PEFR, FEV 1 , FVC and MVV) were repeated at different intervals postoperatively: 24 hours, 1 week, 2 weeks, 4 weeks, 6 weeks, and after MMF removal (24 hours and 1 week). Statistical analysis The data collected were analysed using IBM Statistical Package for Social Sciences (IBM SPSS; IBM Chicago) v 26. The statistical analysis was conducted using an intention-to-treat approach. Descriptive statistics using charts, figures and contingency tables were used in presenting and analysing socio-demographic and anthropometric parameters. Chi-Square, Fisher’s test and Yates continuity correction were applied as appropriate. Normality tests (Shapiro-Wilk and Kolmogorov–Smirnov tests) were performed on continuous variables to assess whether the data followed a normal distribution. This step was essential in determining the appropriate statistical approach, parametric or non-parametric, for comparing variables both between the treatment groups and across different time points. A one-way analysis of variance (ANOVA) was employed to evaluate and compare the effects of the two mandibular fracture treatment modalities (MMF and ORIF) on pulmonary function. This parametric test was used to identify any statistically significant differences in post-treatment pulmonary function parameters (such as FVC, FEV1, and FEV1/FVC ratio) between the two groups. All statistical analyses were conducted with a significance value set at p < 0.05, indicating that differences were considered statistically significant if the probability of occurrence by chance was less than 5%. Additionally, a 95% Confidence Interval (CI) was applied to provide a range within which the true population parameter was expected to lie, ensuring the precision and reliability of the results. Results A total of 66 patients with isolated mandibular fractures were recruited for this study. It comprised 33 patients (group 1) who were treated with open reduction and rigid internal fixation (ORIF) and another 33 patients (group 2) treated with closed reduction with maxillomandibular fixation (MMF). Table 1 a&b showed the socio-demographic characteristics of the study participants, and there was no significant difference in the socio-demographic characteristics of the study participants. Table 2 showed the anthropometric profile of the study participants, and there were no statistically significant differences in age ( p = 0.943), height ( p = 0.278), weight ( p = 0.352) and BMI ( p = 0.239) between the two study groups. Table 3 a&b showed a comparison of the effects of Treatment methods on pulmonary function parameters. At baseline, no statistically significant differences were observed between the ORIF and MMF groups in any of the pulmonary parameters (FEV₁, FVC, FEV₁/FVC, PEFR, MVV), indicating comparable baseline respiratory function ( p > 0.05). However, at 24 hours postoperatively, a statistically significant decrease was seen in all pulmonary parameters for the MMF group compared to ORIF: p < 0.05); FEV ( p < 0.0001), FVC ( p < 0.0001), FEV1/FVC% % ( p = 0.027), PEFR (L/min) ( p < 0.0001) and MVV(L/min) ( p < 0.0001). Similar trends (decrease) persisted at 1 week postoperatively. All parameters were significantly lower in the MMF group ( p < 0.0001): FEV ( p < 0.0001), FVC ( p < 0.0001), PEFR (L/min) ( p < 0.0001) and MVV(L/min) ( p < 0.0001), except FEV₁/FVC ( p = 0.194). The low parameters continued till the 2 weeks postoperatively for the MMF ( p < 0.0001). At 4 weeks postoperatively, there was a gradual improvement of the parameters for MMF (group 2), but still with a significant difference compared to the ORIF group (except for the FEV₁/FVC ratio, which showed a significant increase in the MMF group compared to the ORIF group at 2 and 4 weeks postoperatively). By the 6th week, most pulmonary parameters between the two groups were close to the baselines. However, Forced Vital Capacity (FVC) remained significantly lower ( p = 0.025), while FEV₁/FVC remained significantly higher in the MMF group ( p < 0.0001). At 24 hours after MMF removal, FEV₁/FVC remained significantly higher in the MMF group (88.31% vs. 78.39%, p < 0.0001). FVC is still lower in MMF ( p = 0.002). No significant difference in FEV₁, PEFR, or MVV. And at one week after the removal of maxillomandibular fixation (MMF), patients in the MMF group demonstrated a marked rebound in pulmonary function, with FEV₁/FVC ratio and Peak Expiratory Flow Rate (PEFR) showing statistically significant improvement, exceeding those observed in the ORIF group. Table 1 a: Socio-Demographic Profile of the Study Participants Parameters Groups Total Test statistic P value ORIF MMF Sex Male 14(42.4%) 15(45.5%) 29(43.9%) χ 2 = 0.062 0.804 Female 19(57.6%) 18(54.5%) 37(56.1%) Total 33(100%) 33(100%) 66(100%) Age categories* (years) ≤ 20 4(12.1%) 4(12.1%) 8(12.1%) Fisher’s= 1.000 21–30 17(51.5%) 16(48.5%) 33(50%) 1.055 31–40 12(36.4%) 12(36.4%) 24(36.4%) > 41 0(0%) 1(3%) 1(1.5%) Total 33(100%) 33(100%) 66(100%) Marital Status Single 23(69.7%) 19(57.6%) 42(63.6%) χ 2 = 1.048 0.306 Married 10(30.3%) 14(42.4%) 24(36.4%) Total 33(100%) 33(100%) 66(100%) Tribe Benin 9(27.3%) 8(24.2%) 17(25.8%) Fisher’s= 0.769 Esan 2(6.1%) 5(15.2%) 7(10.6%) 2.805 Igbo 10(30.3%) 9(27.3%) 19(28.8%) Yoruba 3(9.1%) 5(15.2%) 8(12.1%) Urhobo 2(6.1%) 2(6.1%) 4(6.1%) Others 7(21.2%) 4(12.1%) 11(16.7%) Total 33(100%) 33(100%) 66(100%) Table 1 b: Socio-Demographic Profile of the Study Participants Parameters Groups Total Test statistic P value ORIF MMF Religion Christianity 32(97%) 29(87.9%) 61(92.4%) Yates = 0.866 0.352 Islam 1(3%) 4(12.1%) 5(7.6%) Total 33(100%) 33(100%) 66(100%) Social Habit Alcohol Use 7(21.2%) 6(18.2%) 13(19.7%) Fisher’s= 1.000 Smoking 3(9.1%) 4(12.1%) 7(10.6%) 0.599 Alcohol Use & Smoking 2(6.1%) 3(9.1%) 5(7.6%) None 21(63.6%) 20(60.6%) 41(62.1%) Total 33(100%) 33(100%) 66(100%) Educational level Secondary 9(27.3%) 7(21.2%) 16(24.2%) χ 2 = 0.330 0.566 Post-secondary 24(72.7%) 26(78.8%) 50(75.8%) Total 33(100%) 33(100%) 66(100%) Occupation Civil servant 8(24.2%) 8(24.2%) 16(24.2%) Fisher’s = 0.853 Business 12(36.4%) 12(36.4%) 24(36.4%) 1.176 Student 10(30.3%) 12(36.4%) 22(33.3%) Unemployed 3(9.1%) 1(3%) 4(6.1%) Total 33(100%) 33(100%) 66(100%) Table 2 Anthropometric characteristics of the study participants Parameter Group Overall Mean ± SEM F Statistic P value ORIF (Mean ± SEM) MMF (Mean ± SEM) Age (years) 28.42 ± 1.12 28.55 ± 1.27 28.48 ± 0.84 0.005 0.943 Height (m) 1.67 ± 0.01 1.69 ± 0.01 1.68 ± 0.01 1.198 0.278 Weight (kg) 68.64 ± 1.25 70.27 ± 1.21 69.45 ± 0.87 0.878 0.352 BMI (kg/m 2 ) 25.64 ± 0.87 24.52 ± 0.35 25.08 ± 0.47 1.411 0.239 MISS 12.8 ± 1.12 12.2 ± 1.09 12.7 ± 1.11 0.017 0.888 Table 3 a: Comparison of the effects of Treatment methods on pulmonary function parameters ORIF MMF Overall P value (t-test) Preoperative FEV 1 (L) 1.51 ± 0.04 1.66 ± 0.09 1.59 ± 0.05 0.177 FVC (L) 2.02 ± 0.11 2.09 ± 0.12 2.06 ± 0.08 0.674 FEV 1 /FVC % 78.39 ± 2.46 80.83 ± 2.93 79.61 ± 1.9 0.526 PEFR (L/min) 2.09 ± 0.06 2.06 ± 0.1 2.08 ± 0.06 0.777 MVV(L/min) 60.45 ± 1.74 59.56 ± 2.45 60 ± 1.49 0.768 24 hours post-operative FEV 1 (L) 1.36 ± 0.05 0.62 ± 0.05 0.99 ± 0.06 < 0.0001* FVC (L) 1.83 ± 0.09 1.03 ± 0.11 1.43 ± 0.09 < 0.0001* FEV 1 /FVC % 77.62 ± 2.13 69.58 ± 2.84 73.6 ± 1.83 0.027* PEFR (L/min) 1.66 ± 0.06 0.64 ± 0.07 1.15 ± 0.08 < 0.0001* MVV(L/min) 54.93 ± 1.86 25.46 ± 1.96 40.43 ± 2.3 < 0.0001* 1week post-operative FEV 1 (L) 1.43 ± 0.03 0.74 ± 0.05 1.09 ± 0.05 < 0.0001* FVC (L) 2.03 ± 0.08 1.03 ± 0.1 1.53 ± 0.09 < 0.0001* FEV 1 /FVC % 73.29 ± 2.65 77.69 ± 2.04 75.49 ± 1.68 0.194 PEFR (L/min) 2.24 ± 0.08 0.95 ± 0.08 1.59 ± 0.1 < 0.0001* MVV(L/min) 57.12 ± 1.04 29.59 ± 2.15 43.35 ± 2.08 < 0.0001* 2 weeks post-operative FEV 1 (L) 1.47 ± 0.03 1.13 ± 0.06 1.3 ± 0.04 < 0.0001* FVC (L) 2.11 ± 0.09 1.34 ± 0.08 1.72 ± 0.08 < 0.0001* FEV 1 /FVC % 72.83 ± 2.4 84.61 ± 1.99 78.72 ± 1.71 < 0.0001* PEFR (L/min) 2.18 ± 0.09 1.22 ± 0.09 1.7 ± 0.09 < 0.0001* MVV(L/min) 57.02 ± 1.94 44.66 ± 2.66 50.93 ± 1.8 < 0.0001* Table 3 b: Comparison of the effects of Treatment methods on pulmonary function parameters ORIF MMF Overall P value (t-test) 4 weeks post-operative FEV 1 (L) 1.34 ± 0.06 1.15 ± 0.07 1.24 ± 0.05 0.034* FVC (L) 1.77 ± 0.13 1.39 ± 0.09 1.58 ± 0.08 0.017* FEV 1 /FVC % 79.21 ± 2.22 85.33 ± 2.06 82.27 ± 1.55 0.047* PEFR (L/min) 1.65 ± 0.07 1.58 ± 0.09 1.61 ± 0.06 0.546 MVV(L/min) 52.74 ± 2.3 46.03 ± 2.76 49.44 ± 1.82 0.066 6 weeks post-operative FEV 1 (L) 1.29 ± 0.07 1.2 ± 0.07 1.24 ± 0.05 0.382 FVC (L) 1.75 ± 0.13 1.36 ± 0.11 1.56 ± 0.09 0.025* FEV 1 /FVC % 76.75 ± 1.59 87.22 ± 1.45 81.98 ± 1.25 < 0.0001* PEFR (L/min) 1.72 ± 0.11 1.61 ± 0.09 1.67 ± 0.07 0.421 MVV(L/min) 51.47 ± 2.73 48.07 ± 2.9 49.77 ± 1.99 0.397 24 hours after removal of MMF FEV 1 (L) 1.51 ± 0.04 1.42 ± 0.07 1.47 ± 0.04 0.261 FVC (L) 2.02 ± 0.11 1.61 ± 0.08 1.82 ± 0.07 0.002* FEV 1 /FVC % 78.39 ± 2.46 88.31 ± 0.94 83.35 ± 1.44 < 0.0001* PEFR (L/min) 2.09 ± 0.06 2.04 ± 0.1 2.07 ± 0.06 0.654 MVV(L/min) 52.01 ± 2.57 56.98 ± 2.66 54.5 ± 1.86 0.183 1 week after removal of MMF FEV 1 (L) 1.36 ± 0.05 1.51 ± 0.07 1.44 ± 0.04 0.092 FVC (L) 1.83 ± 0.09 1.67 ± 0.07 1.75 ± 0.06 0.201 FEV 1 /FVC % 77.62 ± 2.13 89.81 ± 1.11 83.72 ± 1.41 < 0.0001* PEFR (L/min) 1.66 ± 0.06 2.23 ± 0.1 1.94 ± 0.07 < 0.0001* MVV(L/min) 62.17 ± 1.67 60.51 ± 2.76 61.34 ± 1.6 0.608 Discussion Open reduction and internal fixation (ORIF) and closed reduction with maxillomandibular fixation (MMF) are commonly employed treatment modalities for managing mandibular fractures in various hospital settings across developing countries 1 , 6 . This study aimed to compare the effects of ORIF and MMF on pulmonary function among patients with isolated mandibular fractures, thereby identifying the treatment modality more suitable for individuals with compromised pulmonary status. The study observed a significant female predominance (Table 1 a&b), contrasting previous Nigerian studies 6 , 7 , 14 , 20 . This may reflect improved health-seeking behaviour among women in the study region. This study's findings align with previous studies showing a higher incidence of mandibular fractures among individuals aged 21–30 years 1 , 21 , attributed to increased activity, mobility, and engagement in risky behaviours such as alcohol use, violence, and road accidents 1 , 6 , 20 . However, Sakr et al . in 2006, reported a contrasting high incidence in children aged 0–10 years in Egypt 22 . No statistically significant differences were observed in all pulmonary parameters (FEV₁, FVC, FEV₁/FVC, PEFR, MVV) between the ORIF and MMF groups, suggesting comparable baseline respiratory function ( p > 0.05). However, there was a significant postoperative decline in pulmonary function among MMF patients compared to those treated with ORIF (Table 3 a&b), which is consistent with previous studies 14 , 23 . In the immediate postoperative period (24 hours postoperatively), there was a significant reduction in all pulmonary function parameters evaluated: FEV 1 (L), FVC(L), FEV 1 /FVC%, PEFR(L/min) and MVV(L/min) in the MMF group, compared to the ORIF, which is consistent with other studies 14 , 23 . This resulted in the MMF group being associated with more restrictive and obstructive pulmonary complications in the immediate postoperative phase, as also reported by Doshi et al 12 . This trend was also observed at 2 weeks postoperatively. This observed reduction in pulmonary function among MMF-treated patients may be due to factors such as blood clots, vomitus, laryngeal spasms, airway oedema, and impaired sputum clearance 23 . These findings align with previous studies; Kohno et al 24 reported decreased PEFR, while Amuwha and Saheeb 20 noted reductions in FEV₁ and FVC. Similarly, Adetokunbo et al 7 found significant declines in FEV₁/FVC, FEV₁, and PEFR in MMF patients during the first postoperative week compared to those treated with ORIF. Also, during the first postoperative week, there were marginal increases in the values of FEV 1 (L), FVC(L), FEV 1 /FVC, PEFR(L/min) and MVV(L/min) in both treatment groups. This trend is similar to that reported by Akhiwu et al 6 and Famurewa et al 14 . The gradual increases in pulmonary function parameters are attributable to resolved postoperative oedema with cessation of blood-stained oral secretions 6 . At 4 weeks, differences between the groups narrowed. FEV₁, FVC, and FEV₁/FVC remained statistically different, with MMF showing slightly better FEV₁/FVC. This reflects partial recovery but persistent limitations in lung volumes and ventilatory capacity 7 . This trend indicated that while some degree of respiratory recovery was occurring, the restricted oral airway associated with prolonged jaw immobilisation continued to negatively impact pulmonary performance during this period, which is consistent with other studies 12 , 14 . At postoperative week 6, all measured pulmonary function parameters for the two groups were comparable, as also reported by Famurewa et al 14 except for FVC and FEV 1 /FVC. While FVC lags slightly in MMF patients, the airflow ratio (FEV₁/FVC) overcompensates, thus reflecting recovery dynamics. The lower FVC align with a previous study 12 . FEV 1 /FVC values in the MMF group at the 6th week postoperatively were significantly higher than the respective value in the ORIF group, just as observed in other studies 14 , 25 . This is possible because participants in the MMF group may have acclimatised to the upper airway obstruction while on maxillomaxillary fixation by making an increased effort to overcome the artificial airway obstruction caused by MMF 25 . A week after MMF was released, the values of FVC, FEV 1 and MVV were comparable to corresponding parameters in the ORIF group. At this time, FEV 1 /FVC and PEFR increased in the MMF group to levels significantly higher than the corresponding parameters in the ORIF group. This change in parameters seen in the MMF group after the discontinuation of airway obstruction believed to be caused by MMF in this study was consistent with findings from other studies 14 , 26 , 27 , 28 . But this was in contrast to the study by Famurewa et al 14 . Although MMF remains a cost-effective alternative, ORIF is preferred for patients at risk of respiratory complications due to its minimal impact on pulmonary function and enhanced postoperative care, which is consistent with the previous studies 23 , 25 . Therefore, while previous reports show similar fracture management outcomes between both methods 6 , 14 this study has shown that the same conclusion cannot be drawn concerning pulmonary function parameters. Conclusion This study showed that while both ORIF and MMF are effective for treating mandibular fractures, ORIF offers significant advantages for patients with compromised pulmonary function. ORIF results in less postoperative respiratory impairment due to unrestricted mouth opening, improved ventilation, and easier airway clearance. It also facilitates better oral hygiene, nutrition, and postoperative pulmonary care. This study recommends routine preoperative pulmonary function test for all patients being considered for MMF repair of mandibular fractures. This will ensure that ORIF is prioritised in patients with underlying pulmonary disorders to minimise respiratory complications. Also, MMF patients should be closely monitored, particularly during the first 48 hours postoperatively, which is the period with high proneness to respiratory complications. Abbreviations FEV1: Forced Expiratory Volume in one second FVC: Forced Vital Capacity IBM SPSS: IBM Statistical Package for Social Sciences MISS: Mandible Injury Severity Score MMF: Maxillomandibular Fixation MVV: Maximum Voluntary Ventilation ORIF: Open Reduction and Internal Fixation Peak Expiratory Flow Rate (PEFR) Pulmonary Function Tests (PFTs) RTAs: Road traffic accidents UBTH: University of Benin Teaching Hospital Declarations Ethical approval and consent to participate All patients that participated in this study gave informed consent. And the ethical approval for the study was obtained from the ethics committee of University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. Consent for publication Not applicable Competing interests The authors declare no competing interest. Clinical trial number Not applicable Funding None Author’s contributions Each author contributed significantly to this work. Dr. Chiedu Ogbor Benz conceptualised the work as the primary researcher and carried out the procedures, while Dr. Samuel Gbenga Adetunji ensured data collection and analysis. Prof Peter Esezobor Egbor and Prof Vincent Imagbovomwan Iyawe ensured proper supervision of the work and finalised the manuscripts. Acknowledgements We are grateful for the cooperation received from the University of Benin Teaching Hospital and all the patients who willingly participated in this study. References Adeyemo WL, Iwegbu IO, Bello SA, Okoturo E, Olaitan AA, Ladeinde AL, et al. 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Akhiwu BI, Saheeb DB, Akhiwu HO, Osunde DO, Ojukwu B. The effects of maxillomandibular fixation on ventilatory functions in adult Nigerians. J Heal Res Rev. 2017;4(2):84–7. Adetokunbo FB, Olufunmilayo OF, Babatunde AS, Efosa EG. Pulmonary functions of patients with isolated mandibular fractures: A preliminary report. J Korean Assoc Oral Maxillofac Surg. 2020;46(1):36–40. Koshy J, Feldman E, Chike-Obi C, Bullocks J. Pearls of mandibular trauma management. Semin Plast Surg. 2010;24(4):357–74. RP J. The immobilization period for fractures of the mandibular body. Oral Surg Oral Med Oral Pathol. 1973;36(2):157–63. Ranu H, Wilde M, Brendan M. Pulmonary Function Tests. Ulster Med Soc. 2011;80(2):84–90. Fawibe AE, Odeigah LO, Saka MJ. Reference equations for spirometric indices from a sample of the general adult population in Nigeria. BMC Pulm Med. 2017;17(1):1–11. Doshi K, Shah N, Patel B, Patel N. 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Ventilatory function in healthy adult Nigerians. Clin Sci. 1971;41(3):203–11. Ehrabor G, Fatusi S, Obembe O. Pulmonary functions in ARC-welders in Ile-Ife, Nigeria. East Afr Med J. 2001;78(9):461–4. Fathima A, Giraddi GB, Mamthashri V, Punjabi R, Younus A. Efficacy of Three-dimensional Locking Miniplates versus Three-dimensional Standard Miniplates in the Management of Mandibular Fractures - A Prospective Clinical Study. Ann Maxillofac Surg. 2023;13(2):149–53. Amuwha GO, Saheeb BD. Pulmonary function of adult Nigerians placed on intermaxillary fixation. J Oral Maxillofac Surg. 2009;8(1):43–6. Shah N, Patel S, Sood R, Mansuri Y, Gamit M, Rupawala T. Analysis of mandibular fractures: a 7-year retrospective study. Ann Maxillofac Surg. 2019;9(2):349–54. Sakr K, Farag IA, Zeitoun IM. Review of 509 mandibular fractures treated at the University Hospital, Alexandria, Egypt. Br J Oral Maxillofac Surg. 2006;44(2):107–11. De Carvalho Sampaio TR, Barbosa LM, Lopes AC, De Albuquerque Cavalcanti Almeida R, Do Egito Vasconcelos BC, Gomes ACA, et al. Does Maxillomandibular Fixation Affect Respiratory Function? A Systematic Review. J Craniofac Surg. 2022;33(8):2455–9. Kohno M, Nakajima T, Someya G. Effects of maxillomandibular fixation on respiration. J Oral Maxillofac Surg. 1993;51(9):992–6. Gupta P, Lata J, Verma N, Gowda S. Maxillomandibular Fixation Verses Open Reduction and Internal Fixation in Mandibular Fractures—Effect on Pulmonary Functions. J Maxillofac Oral Surg. 2024;23(6):1627–33. Barak M, Bahouth H, Leiser Y, Abu El-Naaj I. Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach. Biomed Res Int. 2015; 2015(724032):1–9. Patel A, Saadi R, Lighthall JG. Securing the Airway in Maxillofacial Trauma Patients: A Systematic Review of Techniques. Craniomaxillofac Trauma Reconstr. 2020;14(2):100–9. Rozema R, Moumni M, de El GT, Spijkervet FKL, Verbeek R, Kleinbergen JYJ, et al. REDUCTION study group. A clinical decision aid for patients with suspected midfacial and mandibular fractures (the REDUCTION-I study): a prospective multicentre cohort study. Eur J Trauma Emerg Surg. 2022;48(5):4243–54. Additional Declarations No competing interests reported. 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Adetunji","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBAC+QYGBmYGBhsefhAvoYAILQYHwFrSZCQbQFoMiNHCANZy2AakF8IlqIX9dPLrgl9pPMbnVyd+eGDAIM8vdgC/Fvme3G3WM/tseMxuvN0sAXSY4czZCQSsOZC7zZi3Jw2o5ewGkJYEg9uEtJx/C9JymMd4xtnNP4jTciN382OeH4d5DPh7txFni8GNt9uYZzak8Ujc4N1mkWAgQdgv8v25mz8X/LGx5+8/u/nmjwobeX5pQg5jYGCTYGwDUhJglRIElYMA8weGP0CK/wBRqkfBKBgFo2AEAgDRcUlwl2Q7QAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Benin Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Samuel","middleName":"Gbenga","lastName":"Adetunji","suffix":""},{"id":532204090,"identity":"092b0f54-1760-4ecd-9f33-8c1b427f1f91","order_by":2,"name":"Peter Esezobor Egbor","email":"","orcid":"","institution":"University of Benin","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"Esezobor","lastName":"Egbor","suffix":""},{"id":532204091,"identity":"7c256068-5fdf-4031-a984-2c82a98129be","order_by":3,"name":"Vincent Imagbovomwan Iyawe","email":"","orcid":"","institution":"University of Benin","correspondingAuthor":false,"prefix":"","firstName":"Vincent","middleName":"Imagbovomwan","lastName":"Iyawe","suffix":""}],"badges":[],"createdAt":"2025-08-25 19:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7456482/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7456482/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94055254,"identity":"f12c44fc-abe7-4bfa-8115-4612fc929cbf","added_by":"auto","created_at":"2025-10-22 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03:13:58","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":136967,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7456482/v1/458b91511cb63869d8aef094.html"},{"id":94055537,"identity":"ca82546c-030c-4c4f-9a24-d5eea6d0b3c4","added_by":"auto","created_at":"2025-10-22 03:29:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1058005,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7456482/v1/04776651-3ea2-4644-96e3-60a0a1882c29.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Treatment Modalities for Mandibular Fracture in Patients with Compromised Pulmonary Function","fulltext":[{"header":"Background","content":"\u003cp\u003eMandibular fractures are among the most common facial skeletal injuries and account for a significant proportion of cases managed by Oral and Maxillofacial surgeons\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In many developing countries, road traffic accidents (RTAs) remain the leading cause of these injuries, largely due to the lack of strict enforcement of traffic regulations or the widespread disregard for existing laws\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Other notable causes include interpersonal assaults, gunshot wounds, contact sports, and industrial accidents\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMandibular fractures rarely cause respiratory complications\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. However, in uncommon cases, such as when the anterior attachment of the genioglossus muscle is disrupted\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e or in bilateral body fractures of the mandible (flail mandible), the tongue may displace posteriorly, leading to airway obstruction\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The standard treatment for mandibular fractures is Open Reduction and Internal Fixation (ORIF), which involves surgical exposure, anatomical reduction of the fracture, and stabilisation with plates and screws\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. This technique, typically performed under general anaesthesia, allows for immediate mandibular function but requires specialised skills, instruments, and is cost-intensive\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. In contrast, Closed Reduction with Maxillomandibular Fixation (MMF) remains in use in some low- and middle-income countries\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Closed reduction with maxillomandibular fixation (MMF) involves aligning mandibular fracture segments indirectly by establishing correct dental occlusion, without direct visualisation of the fracture sites\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAccording to Juniper and Awty\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, the typical duration of immobilisation in mandibular fracture management ranges from 3 to 6 weeks. During immobilisation, the mouth is kept closed to minimise interfragmentary movement, thereby restricting full mandibular excursive function. Pulmonary Function Tests (PFTs\u003cb\u003e)\u003c/b\u003e such as Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV\u003csub\u003e1\u003c/sub\u003e), Peak Expiratory Flow Rate (PEFR), Maximum Voluntary Ventilation (MVV), and their derivatives are important non-invasive measures used to evaluate lung performance. PFTs provide important information relating to the large and small airways, the pulmonary parenchyma and the size and integrity of the pulmonary capillary bed\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. The tests have also become part of routine health examinations in respiratory, occupational, and sports medicine\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. They have evolved from tools for physiologic study to clinical tools widely used in assessing respiratory status\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. These parameters are especially crucial when planning surgical interventions in patients with potential airway compromise\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWhile both ORIF and MMF methods are effective in achieving bone union and restoring occlusion, their impact on pulmonary function has not been extensively studied. Therefore this study aimed to compare the effects of ORIF and MMF on pulmonary function among patients with mandibular fractures, thereby identifying the treatment modality more suitable for individuals with compromised pulmonary status.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe study design was a randomised comparative longitudinal study that compared the effects of ORIF and MMF on pulmonary function among patients with mandibular fractures. The study population comprised patients with clinical and radiological features of isolated mandibular fractures who presented to the study centres: Oral and Maxillofacial Surgery Clinic, University of Benin Teaching Hospital (UBTH), Benin City, Edo State. The study was conducted between February 2022 and December 2022.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003efor this study was obtained. And written consent was signed by all eligible participants who participated in the study. Other inclusion criteria were absence of concomitant fracture in other parts of the body, patients with no missing anterior teeth (which could allow mouth breathing for the MMF group), patients with no history of obstructive or restrictive respiratory disease and whose preoperative pulmonary function tests were within the normal range, patients who tolerated mouth closure (MMF) for six weeks, American Society of Anesthesiologists physical status 1 (ASA 1) patients, and patients without any comorbidity that adversely affected the procedure. Patients with edentulous mandibular and/or maxillary arch(es) that affected the placement of MMF and those who declined the modality of treatment based on finance or preference were excluded. Similarly, patients with psychiatric illness/mental impairment, uncontrolled or poorly controlled seizures, patients with a history of head and neck cancer or radiotherapy, chronic smokers, alcoholics, pregnant or lactating patients and patients on oral contraceptives or/and anticoagulant therapy were all excluded from the study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe minimum sample size was calculated using the appropriate sample size formular\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, with values from a previous study\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Thus, 66 participants were recruited for the study groups and were assigned into two equal groups of thirty-three (33) participants each, using a computer-based randomisation technique in GraghPad.\u003c/p\u003e\u003cp\u003eParticipants\u0026rsquo; biodata, type of mandibular fracture, height, weight, Mandible Injury Severity Score (MISS) and any relevant medical history were taken, and information was recorded preoperatively. All patients were exposed to a posterior-anterior jaw view, oblique left and right lateral views of the mandible and the type of mandibular fracture was determined. The Mandible Injury Severity Score MISS was calculated for each participant, as described by Shetty \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The procedure for pulmonary function tests was explained to the participants and performed according to the American Thoracic Society and European Thoracic Society standards and recommendations.\u003c/p\u003e\u003cp\u003eForced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV\u003csub\u003e1\u003c/sub\u003e), Peak Expiratory Flow Rate (PEFR), and the ratio of FEV\u003csub\u003e1\u003c/sub\u003e to FVC were measured for all participants just before treatment using a spirometer. Also, Maximum Voluntary Ventilation (MVV) was measured, and the ratios of MVV to predicted MVV (%MVV) and the MVV to body surface area (BSA) were calculated\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Predicted values of pulmonary function parameters (FVC [L], FEV\u003csub\u003e1\u003c/sub\u003e [L], FEV\u003csub\u003e1\u003c/sub\u003e/FVC [%], PEFR [L/s]) and MVV were determined using reference values for Nigerians\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. The measured baseline/preoperative pulmonary function values from all patients were compared with the predicted values, and the result obtained (FEV\u003csub\u003e1\u003c/sub\u003e/FVC) was used to ensure that only participants whose FEV\u003csub\u003e1\u003c/sub\u003e/FVC value was \u0026gt;\u0026thinsp;80% and with a normal pulmonary function pattern were recruited/enrolled for the study\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSurgical procedures (ORIF or MMF) were carried for all participants by a team of surgeons.\u003c/p\u003e\u003cp\u003eFor the ORIF group (group 1), the fracture site was surgically exposed under general anaesthesia, and fracture segments were anatomically reduced and secured in place using 2.0mm titanium miniplates positioned to ensure stable alignment during healing as described by Singla \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e4\u003c/sup\u003e and Fathima \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e9\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFor the MMF group (group 2), the procedures were performed under local anaesthesia (2% lignocaine in 1:100,000 adrenaline). The fractures were indirectly reduced and stabilised by mandibular-maxillary fixation (MMF) using tie wires. All participants in this group remained on MMF for a continuous period of six weeks, after which the fixation was carefully released, following clinical and radiographic confirmation of satisfactory bone healing and stability.\u003c/p\u003e\u003cp\u003eParticipants in both groups received appropriate standard postoperative care to promote healing, minimise complications, and ensure overall patient well-being.\u003c/p\u003e\u003cp\u003eAfter the surgical procedures, the pulmonary function tests (PEFR, FEV\u003csub\u003e1\u003c/sub\u003e, FVC and MVV) were repeated at different intervals postoperatively: 24 hours, 1 week, 2 weeks, 4 weeks, 6 weeks, and after MMF removal (24 hours and 1 week).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003cp\u003eThe data collected were analysed using IBM Statistical Package for Social Sciences (IBM SPSS; IBM Chicago) v 26. The statistical analysis was conducted using an intention-to-treat approach. Descriptive statistics using charts, figures and contingency tables were used in presenting and analysing socio-demographic and anthropometric parameters. Chi-Square, Fisher\u0026rsquo;s test and Yates continuity correction were applied as appropriate. Normality tests (Shapiro-Wilk and Kolmogorov\u0026ndash;Smirnov tests) were performed on continuous variables to assess whether the data followed a normal distribution. This step was essential in determining the appropriate statistical approach, parametric or non-parametric, for comparing variables both between the treatment groups and across different time points.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eA one-way analysis of variance (ANOVA) was employed to evaluate and compare the effects of the two mandibular fracture treatment modalities (MMF and ORIF) on pulmonary function. This parametric test was used to identify any statistically significant differences in post-treatment pulmonary function parameters (such as FVC, FEV1, and FEV1/FVC ratio) between the two groups. All statistical analyses were conducted with a significance value set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, indicating that differences were considered statistically significant if the probability of occurrence by chance was less than 5%. Additionally, a 95% Confidence Interval (CI) was applied to provide a range within which the true population parameter was expected to lie, ensuring the precision and reliability of the results.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 66 patients with isolated mandibular fractures were recruited for this study. It comprised 33 patients (group 1) who were treated with open reduction and rigid internal fixation (ORIF) and another 33 patients (group 2) treated with closed reduction with maxillomandibular fixation (MMF). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea\u0026amp;b showed the socio-demographic characteristics of the study participants, and there was no significant difference in the socio-demographic characteristics of the study participants. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e showed the anthropometric profile of the study participants, and there were no statistically significant differences in age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.943), height (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.278), weight (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.352) and BMI (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.239) between the two study groups.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003ea\u0026amp;b showed a comparison of the effects of Treatment methods on pulmonary function parameters. At baseline, no statistically significant differences were observed between the ORIF and MMF groups in any of the pulmonary parameters (FEV₁, FVC, FEV₁/FVC, PEFR, MVV), indicating comparable baseline respiratory function (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, at 24 hours postoperatively, a statistically significant decrease was seen in all pulmonary parameters for the MMF group compared to ORIF: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); FEV (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), FVC (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), FEV1/FVC% % (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027), PEFR (L/min) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and MVV(L/min) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\u003cp\u003eSimilar trends (decrease) persisted at 1 week postoperatively. All parameters were significantly lower in the MMF group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001): FEV (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), FVC (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), PEFR (L/min) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and MVV(L/min) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), except FEV₁/FVC (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.194). The low parameters continued till the 2 weeks postoperatively for the MMF (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). At 4 weeks postoperatively, there was a gradual improvement of the parameters for MMF (group 2), but still with a significant difference compared to the ORIF group (except for the FEV₁/FVC ratio, which showed a significant increase in the MMF group compared to the ORIF group at 2 and 4 weeks postoperatively). By the 6th week, most pulmonary parameters between the two groups were close to the baselines. However, Forced Vital Capacity (FVC) remained significantly lower (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025), while FEV₁/FVC remained significantly higher in the MMF group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\u003cp\u003eAt 24 hours after MMF removal, FEV₁/FVC remained significantly higher in the MMF group (88.31% vs. 78.39%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). FVC is still lower in MMF (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). No significant difference in FEV₁, PEFR, or MVV. And at one week after the removal of maxillomandibular fixation (MMF), patients in the MMF group demonstrated a marked rebound in pulmonary function, with FEV₁/FVC ratio and Peak Expiratory Flow Rate (PEFR) showing statistically significant improvement, exceeding those observed in the ORIF group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ea: Socio-Demographic Profile of the Study Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest statistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eORIF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMMF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(42.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(45.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29(43.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;0.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.804\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19(57.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(54.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(56.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge categories* (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(12.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(12.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(12.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFisher\u0026rsquo;s=\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17(51.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(48.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33(50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(1.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23(69.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(57.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42(63.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;1.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.306\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(30.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(42.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTribe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBenin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(24.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(25.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFisher\u0026rsquo;s=\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.769\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEsan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(15.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(10.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.805\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIgbo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(30.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(28.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYoruba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(15.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(12.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrhobo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(21.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(12.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11(16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eb: Socio-Demographic Profile of the Study Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest statistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eORIF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMMF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChristianity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32(97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(87.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61(92.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYates\u0026thinsp;=\u0026thinsp;0.866\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.352\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(12.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(7.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSocial Habit\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol Use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(21.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(18.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(19.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFisher\u0026rsquo;s=\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(12.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(10.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.599\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol Use \u0026amp; Smoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(7.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21(63.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(60.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41(62.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(21.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(24.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;0.330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.566\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost-secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24(72.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(78.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50(75.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCivil servant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(24.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(24.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(24.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFisher\u0026rsquo;s =\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.853\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBusiness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(30.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22(33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnthropometric characteristics of the study participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SEM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eF Statistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eORIF\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SEM)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMMF\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SEM)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e28.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e28.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e28.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.943\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHeight (m)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.278\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeight (kg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e68.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e69.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.878\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.352\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e25.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e24.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e25.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.411\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.239\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMISS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.888\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ea: Comparison of the effects of Treatment methods on pulmonary function parameters\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eORIF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMMF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value (t-test)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e(L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.177\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFVC (L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.674\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e/FVC %\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e78.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e80.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e79.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.526\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePEFR (L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.777\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMVV(L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e60.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e59.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.768\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e24 hours post-operative\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e(L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFVC (L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e/FVC %\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e77.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e69.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e73.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.027*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePEFR (L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMVV(L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e54.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e25.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e40.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1week post-operative\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e(L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFVC (L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e/FVC %\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e73.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e77.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e75.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.194\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePEFR (L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMVV(L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e57.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e29.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e43.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2 weeks post-operative\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e(L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFVC (L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e/FVC %\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e84.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e78.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePEFR (L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMVV(L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e57.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e50.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eb: Comparison of the effects of Treatment methods on pulmonary function parameters\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eORIF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMMF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value (t-test)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003e4 weeks post-operative\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e(L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.034*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFVC (L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.017*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e/FVC %\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e79.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e85.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e82.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.047*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePEFR (L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.546\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMVV(L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e52.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e46.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e49.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.066\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e6 weeks post-operative\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e(L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.382\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFVC (L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.025*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e/FVC %\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e76.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e87.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e81.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePEFR (L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.421\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMVV(L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e51.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e48.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e49.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.397\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e24 hours after removal of MMF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e(L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.261\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFVC (L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e/FVC %\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e78.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e88.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e83.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePEFR (L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.654\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMVV(L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e52.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e56.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e54.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.183\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1 week after removal of MMF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e(L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFVC (L)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.201\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFEV\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e/FVC %\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e77.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e89.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e83.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePEFR (L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMVV(L/min)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e62.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e60.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e61.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.608\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOpen reduction and internal fixation (ORIF) and closed reduction with maxillomandibular fixation (MMF) are commonly employed treatment modalities for managing mandibular fractures in various hospital settings across developing countries\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. This study aimed to compare the effects of ORIF and MMF on pulmonary function among patients with isolated mandibular fractures, thereby identifying the treatment modality more suitable for individuals with compromised pulmonary status.\u003c/p\u003e\u003cp\u003eThe study observed a significant female predominance (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea\u0026amp;b), contrasting previous Nigerian studies\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. This may reflect improved health-seeking behaviour among women in the study region. This study's findings align with previous studies showing a higher incidence of mandibular fractures among individuals aged 21\u0026ndash;30 years\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, attributed to increased activity, mobility, and engagement in risky behaviours such as alcohol use, violence, and road accidents\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. However, Sakr \u003cem\u003eet al\u003c/em\u003e. in 2006, reported a contrasting high incidence in children aged 0\u0026ndash;10 years in Egypt\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eNo statistically significant differences were observed in all pulmonary parameters (FEV₁, FVC, FEV₁/FVC, PEFR, MVV) between the ORIF and MMF groups, suggesting comparable baseline respiratory function (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, there was a significant postoperative decline in pulmonary function among MMF patients compared to those treated with ORIF (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003ea\u0026amp;b), which is consistent with previous studies\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. In the immediate postoperative period (24 hours postoperatively), there was a significant reduction in all pulmonary function parameters evaluated: FEV\u003csub\u003e1\u003c/sub\u003e(L), FVC(L), FEV\u003csub\u003e1\u003c/sub\u003e/FVC%, PEFR(L/min) and MVV(L/min) in the MMF group, compared to the ORIF, which is consistent with other studies\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. This resulted in the MMF group being associated with more restrictive and obstructive pulmonary complications in the immediate postoperative phase, as also reported by Doshi \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This trend was also observed at 2 weeks postoperatively. This observed reduction in pulmonary function among MMF-treated patients may be due to factors such as blood clots, vomitus, laryngeal spasms, airway oedema, and impaired sputum clearance\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. These findings align with previous studies; Kohno \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e reported decreased PEFR, while Amuwha and Saheeb\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e noted reductions in FEV₁ and FVC. Similarly, Adetokunbo \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e found significant declines in FEV₁/FVC, FEV₁, and PEFR in MMF patients during the first postoperative week compared to those treated with ORIF.\u003c/p\u003e\u003cp\u003eAlso, during the first postoperative week, there were marginal increases in the values of FEV\u003csub\u003e1\u003c/sub\u003e(L), FVC(L), FEV\u003csub\u003e1\u003c/sub\u003e/FVC, PEFR(L/min) and MVV(L/min) in both treatment groups. This trend is similar to that reported by Akhiwu \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e and Famurewa \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The gradual increases in pulmonary function parameters are attributable to resolved postoperative oedema with cessation of blood-stained oral secretions\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAt 4 weeks, differences between the groups narrowed. FEV₁, FVC, and FEV₁/FVC remained statistically different, with MMF showing slightly better FEV₁/FVC. This reflects partial recovery but persistent limitations in lung volumes and ventilatory capacity\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. This trend indicated that while some degree of respiratory recovery was occurring, the restricted oral airway associated with prolonged jaw immobilisation continued to negatively impact pulmonary performance during this period, which is consistent with other studies\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAt postoperative week 6, all measured pulmonary function parameters for the two groups were comparable, as also reported by Famurewa \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e except for FVC and FEV\u003csub\u003e1\u003c/sub\u003e/FVC. While FVC lags slightly in MMF patients, the airflow ratio (FEV₁/FVC) overcompensates, thus reflecting recovery dynamics. The lower FVC align with a previous study\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. FEV\u003csub\u003e1\u003c/sub\u003e/FVC values in the MMF group at the 6th week postoperatively were significantly higher than the respective value in the ORIF group, just as observed in other studies\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. This is possible because participants in the MMF group may have acclimatised to the upper airway obstruction while on maxillomaxillary fixation by making an increased effort to overcome the artificial airway obstruction caused by MMF\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eA week after MMF was released, the values of FVC, FEV\u003csub\u003e1\u003c/sub\u003e and MVV were comparable to corresponding parameters in the ORIF group. At this time, FEV\u003csub\u003e1\u003c/sub\u003e/FVC and PEFR increased in the MMF group to levels significantly higher than the corresponding parameters in the ORIF group. This change in parameters seen in the MMF group after the discontinuation of airway obstruction believed to be caused by MMF in this study was consistent with findings from other studies\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. But this was in contrast to the study by Famurewa \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAlthough MMF remains a cost-effective alternative, ORIF is preferred for patients at risk of respiratory complications due to its minimal impact on pulmonary function and enhanced postoperative care, which is consistent with the previous studies\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Therefore, while previous reports show similar fracture management outcomes between both methods\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e this study has shown that the same conclusion cannot be drawn concerning pulmonary function parameters.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study showed that while both ORIF and MMF are effective for treating mandibular fractures, ORIF offers significant advantages for patients with compromised pulmonary function. ORIF results in less postoperative respiratory impairment due to unrestricted mouth opening, improved ventilation, and easier airway clearance. It also facilitates better oral hygiene, nutrition, and postoperative pulmonary care. This study recommends routine preoperative pulmonary function test for all patients being considered for MMF repair of mandibular fractures. This will ensure that ORIF is prioritised in patients with underlying pulmonary disorders to minimise respiratory complications. Also, MMF patients should be closely monitored, particularly during the first 48 hours postoperatively, which is the period with high proneness to respiratory complications.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFEV1: Forced Expiratory Volume in one second\u003c/p\u003e\n\u003cp\u003eFVC: Forced Vital Capacity\u003c/p\u003e\n\u003cp\u003eIBM SPSS: IBM Statistical Package for Social Sciences\u003c/p\u003e\n\u003cp\u003eMISS: Mandible Injury Severity Score\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMMF: Maxillomandibular Fixation\u003c/p\u003e\n\u003cp\u003eMVV: Maximum Voluntary Ventilation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eORIF: Open Reduction and Internal Fixation \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePeak Expiratory Flow Rate (PEFR)\u003c/p\u003e\n\u003cp\u003ePulmonary Function Tests (PFTs)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRTAs: Road traffic accidents\u003c/p\u003e\n\u003cp\u003eUBTH: University of Benin Teaching Hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients that participated in this study gave informed consent. And the ethical approval for the study was obtained from the ethics committee of University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach author contributed significantly to this work. Dr. Chiedu Ogbor Benz conceptualised the work as the primary researcher and carried out the procedures, while Dr. Samuel Gbenga Adetunji ensured data collection and analysis. Prof Peter Esezobor Egbor and Prof Vincent Imagbovomwan Iyawe ensured proper supervision of the work and finalised the manuscripts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful for the cooperation received from the University of Benin Teaching Hospital and all the patients who willingly participated in this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdeyemo WL, Iwegbu IO, Bello SA, Okoturo E, Olaitan AA, Ladeinde AL, et al. Management of mandibular fractures in a developing country: A review of 314 cases from two urban centers in Nigeria. World J Surg. 2008;32(12):2631\u0026ndash;26355.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePapadiochos I, Goutzanis L, Karydi KI, Kalfarentzos E, Papadogeorgakis N. Flared sign of flail mandible on computed tomography: an unstable fracture associated with a compromised airway. Br J Oral Maxillofac Surg. 2017;55(9):968\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFujioka M. Split Fracture and Displacement of Mandibular Lingual Cortical Plate of Mandibular Symphysis Requires Fixation. Trauma Cases Rev. 2015;1(4):1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingla S, Narula R, Kuthiala P, Mittal A, Brar HS, Singla M. Management of Mandibular Angle Fractures Using Single Y-Shaped Titanium Miniplate at the Superior Border: A Prospective Clinical Study. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):4495\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFamurewa BA, Aregbesola SB, Alade OT, Akinniyi TA. Treatment costs of mandibular fractures in a Nigerian hospital. Oral Maxillofac Surg. 2022;26(3):417\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkhiwu BI, Saheeb DB, Akhiwu HO, Osunde DO, Ojukwu B. The effects of maxillomandibular fixation on ventilatory functions in adult Nigerians. J Heal Res Rev. 2017;4(2):84\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdetokunbo FB, Olufunmilayo OF, Babatunde AS, Efosa EG. Pulmonary functions of patients with isolated mandibular fractures: A preliminary report. J Korean Assoc Oral Maxillofac Surg. 2020;46(1):36\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoshy J, Feldman E, Chike-Obi C, Bullocks J. Pearls of mandibular trauma management. Semin Plast Surg. 2010;24(4):357\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRP J. The immobilization period for fractures of the mandibular body. Oral Surg Oral Med Oral Pathol. 1973;36(2):157\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRanu H, Wilde M, Brendan M. Pulmonary Function Tests. Ulster Med Soc. 2011;80(2):84\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFawibe AE, Odeigah LO, Saka MJ. Reference equations for spirometric indices from a sample of the general adult population in Nigeria. BMC Pulm Med. 2017;17(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDoshi K, Shah N, Patel B, Patel N. Evaluation of Effect of Intermaxillary Fixation on Pulmonary Functions of Non-trauma Volunteers: An Observational Study. Indo-European Jourenal Dent Ther Res. 2016;5(2):357\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCharan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFamurewa BA, Oginni FO, Aregbesola SB, Erhabor GE. Effects of maxillomandibular fixation and rigid internal fixation on pulmonary function in patients with mandibular fractures. Int J Oral Maxillofac Surg. 2020;49(9):1193\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShetty B, Fazal I, Khan SF, Nambiar M, Khadijathul Irfana D, Prasad R, et al. Association between cardiovascular diseases and periodontal disease: more than what meets the eye. Drug Target Insights. 2023;17:31\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFulton JE, Pivarnik JM, Taylor WC, Snider SA, Tate AL, Frankowski RF. Prediction of maximum voluntary ventilation (MVV) in African-American adolescent girls. Pediatr Pulmonol. 1995;20(4):225\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFemi-Pearse D, Elebute E. Ventilatory function in healthy adult Nigerians. Clin Sci. 1971;41(3):203\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEhrabor G, Fatusi S, Obembe O. Pulmonary functions in ARC-welders in Ile-Ife, Nigeria. East Afr Med J. 2001;78(9):461\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFathima A, Giraddi GB, Mamthashri V, Punjabi R, Younus A. Efficacy of Three-dimensional Locking Miniplates versus Three-dimensional Standard Miniplates in the Management of Mandibular Fractures - A Prospective Clinical Study. Ann Maxillofac Surg. 2023;13(2):149\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmuwha GO, Saheeb BD. Pulmonary function of adult Nigerians placed on intermaxillary fixation. J Oral Maxillofac Surg. 2009;8(1):43\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah N, Patel S, Sood R, Mansuri Y, Gamit M, Rupawala T. Analysis of mandibular fractures: a 7-year retrospective study. Ann Maxillofac Surg. 2019;9(2):349\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSakr K, Farag IA, Zeitoun IM. Review of 509 mandibular fractures treated at the University Hospital, Alexandria, Egypt. Br J Oral Maxillofac Surg. 2006;44(2):107\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDe Carvalho Sampaio TR, Barbosa LM, Lopes AC, De Albuquerque Cavalcanti Almeida R, Do Egito Vasconcelos BC, Gomes ACA, et al. Does Maxillomandibular Fixation Affect Respiratory Function? A Systematic Review. J Craniofac Surg. 2022;33(8):2455\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKohno M, Nakajima T, Someya G. Effects of maxillomandibular fixation on respiration. J Oral Maxillofac Surg. 1993;51(9):992\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGupta P, Lata J, Verma N, Gowda S. Maxillomandibular Fixation Verses Open Reduction and Internal Fixation in Mandibular Fractures\u0026mdash;Effect on Pulmonary Functions. J Maxillofac Oral Surg. 2024;23(6):1627\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarak M, Bahouth H, Leiser Y, Abu El-Naaj I. Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach. Biomed Res Int. 2015; 2015(724032):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel A, Saadi R, Lighthall JG. Securing the Airway in Maxillofacial Trauma Patients: A Systematic Review of Techniques. Craniomaxillofac Trauma Reconstr. 2020;14(2):100\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRozema R, Moumni M, de El GT, Spijkervet FKL, Verbeek R, Kleinbergen JYJ, et al. REDUCTION study group. A clinical decision aid for patients with suspected midfacial and mandibular fractures (the REDUCTION-I study): a prospective multicentre cohort study. Eur J Trauma Emerg Surg. 2022;48(5):4243\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mandibular fracture, ORIF, MMF, Pulmonary function, Spirometry, Airway obstruction, Maxillofacial trauma","lastPublishedDoi":"10.21203/rs.3.rs-7456482/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7456482/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMandibular fractures are among the most common facial injuries managed by oral and maxillofacial surgeons, with road traffic accidents as the leading cause in many developing countries. While Open Reduction and Internal Fixation (ORIF) and Closed Reduction with Maxillomandibular Fixation (MMF) are both effective treatment modalities, their differential impacts on pulmonary function remain understudied. The objective of the study was to compare the effects of ORIF and MMF on pulmonary function in patients with isolated mandibular fractures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA randomised comparative longitudinal study was conducted among 66 patients with isolated mandibular fractures. Participants were equally assigned to Open Reduction and Internal Fixation (group 1) and Closed Reduction with Maxillomandibular Fixation (group 2) groups. Preoperative and postoperative pulmonary function tests were carried out at different intervals using standard protocols. Data were analysed using SPSS version 26 with significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBoth groups showed comparable baseline pulmonary function. However, group 2 patients experienced a significant decline in pulmonary parameters at 24 hours, 1 week, and 2 weeks postoperatively. Although recovery was observed by the 4th and 6th weeks, Forced Vital Capacity (FVC) remained lower in group 2, while FEV₁/FVC was significantly higher. One week after MMF removal, Peak Expiratory Flow Rate (PEFR) and FEV₁/FVC values rebounded significantly in the MMF (group 2).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eEven though MMF remains a viable, low-cost option of managing mandibular fractures, ORIF is associated with less respiratory impairment and may be better suited for patients at risk of pulmonary complications. These findings also underscore the importance of individualised treatment planning.\u003c/p\u003e","manuscriptTitle":"Assessment of Treatment Modalities for Mandibular Fracture in Patients with Compromised Pulmonary Function","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 03:13:53","doi":"10.21203/rs.3.rs-7456482/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-20T09:04:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T15:09:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21158642267960630397605851318457089809","date":"2025-10-10T22:50:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T10:48:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86553461686073473967023494538185390060","date":"2025-10-09T00:59:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46014445936733233963258732115248324460","date":"2025-10-08T18:55:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-08T18:36:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-01T09:37:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-10T11:26:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-08T13:25:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-09-08T09:29:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bdb1bcab-067b-42c3-bcbd-aa71c60fe44c","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-22T03:13:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-22 03:13:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7456482","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7456482","identity":"rs-7456482","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}