Nonsurgical Orthodontic Splinting of Mandibular Fracture in a Young Child: 10-Year Follow-Up

Abstract

The management of mandibular fractures in children differs from that of adults because of concerns about mandibular growth and dentition development. 1 Schweinfurth J.M. Koltai P.J. Pediatric mandibular fractures. Facial Plast Surg. 1998; 14: 31 Crossref PubMed Scopus (25) Google Scholar , 2 Amaratunga N.A. Mandibular fractures in children: A study of clinical aspects, treatment needs and complications. J Oral Maxillofac Surg. 1988; 46: 637 Abstract Full Text PDF PubMed Scopus (52) Google Scholar , 3 Ellis E. 10 years of mandibular fractures: An analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol. 1985; 59: 120 Abstract Full Text PDF PubMed Scopus (414) Google Scholar , 4 Demianczuk A.N. Verchere C. Phillips J.H. The effect on facial growth of pediatric mandibular fractures. J Craniofac Surg. 1999; 10: 323 Crossref PubMed Scopus (56) Google Scholar , 5 Rowe N.L. Fractures of the jaws in children. J Oral Surg. 1969; 27: 497 PubMed Google Scholar , 6 Tanaka N. Uchide N. Suzuki K. et al. Maxillofacial fractures in children. J Craniomaxillofac Surg. 1993; 21: 289 Abstract Full Text PDF PubMed Scopus (76) Google Scholar Treatment modalities in young patients range from conservative treatment methods (eg, arch-bars, eyelets) to open reduction with internal fixation. 7 Smartt Jr, J.M. Low D.W. Bartlett S.P. The pediatric mandible, II: Management of traumatic injury or fracture. Plast Reconstr Surg. 2005; 116: 28e Crossref PubMed Google Scholar Maxillomandibular fixation (MMF) including arch-bars or eyelets can cause avulsion of primary teeth that are insufficiently stable. The conical shape of the primary teeth, with their wide cervical margins and tapered occlusal surface, makes placement of these MMF devices or eyelets technically challenging. 1 Schweinfurth J.M. Koltai P.J. Pediatric mandibular fractures. Facial Plast Surg. 1998; 14: 31 Crossref PubMed Scopus (25) Google Scholar , 8 Wong G.B. Pediatric mandibular fractures treated by rigid internal fixation. J Can Dent Assoc. 1993; 59: 759 PubMed Google Scholar , 9 Nishioka G.J. Larrabee W.F. Murakami C.S. et al. Suspended circummandibular wire fixation for mixed-dentition pediatric mandible fractures. Arch Otolaryngol Head Neck Surg. 1997; 123: 753 Crossref PubMed Scopus (17) Google Scholar Internal rigid or semirigid fixation using titanium miniplates and screws or resorbable osteosynthesis plates and screws has become a standard of care for young adult and adult patients; however, its suitability in children remains controversial. 1 Schweinfurth J.M. Koltai P.J. Pediatric mandibular fractures. Facial Plast Surg. 1998; 14: 31 Crossref PubMed Scopus (25) Google Scholar , 10 Crean S.T. Sivarajasingam V. Fardy M.J. Conservative approach in the management of mandibular fractures in the early dentition phase: A case report and review of the literature. Int J Paediatr Dent. 2000; 10: 229 Crossref PubMed Scopus (21) Google Scholar , 11 Imola M.J. Hamlar D.D. Shao W. et al. Resorbable plate fixation in pediatric craniofacial surgery: Long-term outcome. Arch Facial Plast Surg. 2001; 3: 79 Crossref PubMed Scopus (122) Google Scholar There are many concerns about the effect of implanted hardware in the mandible of the growing child. In addition, some evidence suggests that disruption of the functional matrix bone may result in altered development. The potential for damage to the periosteum and the surrounding soft tissue must be taken into consideration when choosing an internal fixation technique. 12 Kaban L.B. Diagnosis and treatment of fractures of facial bones in children 1943–1993. J Oral Maxillofac Surg. 1993; 51: 722 Abstract Full Text PDF PubMed Scopus (127) Google Scholar , 13 Posnick J.C. Wells M. Pron G.E. Paediatric facial fractures: Evolving patterns of treatment. J Oral Maxillofac Surg. 1993; 51: 836 Abstract Full Text PDF PubMed Scopus (227) Google Scholar , 14 Remi M. Christine M.C. Gael P. et al. Mandibular fractures in children: Long-term results. Int J Pediatr Otorhinolaryngol. 2003; 67: 25 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar , 15 Yarington Jr, C.T. Maxillofacial trauma in children. Otolaryngol Clin North Am. 1977; 10: 25 PubMed Google Scholar