Pediatric mandibular fracture with concomitant craniovertebral ligament injuries and retroclival hematoma: A rare occurrence

Abstract

The mandible is one of the most commonly fractured facial bone in children. The principle of management of pediatric mandibular fracture bears no resemblance to its adult counterpart due to concerns regarding the growing facial skeleton and development of dentition. Pediatric mandibular fractures with traumatic retroclival hematoma and concomitant craniovertebral junction injuries is an extremely rare entity reported in literature. Manipulation during operative procedure for mandibular fractures could potentially cause serious injuries to the spinal cord, leading to significant disability and mortality. The authors report a case of a 12-year-old child with right parasymphysis and left angle of mandible fracture treated by open reduction internal fixation (ORIF). Her craniovertebral ligamentous injuries and retroclival hematoma were treated conservatively with good outcome. The presence of a halo frame for cervical spine stabilization during ORIF contributed to the difficulty in operative management. • Attending surgeons should have a high level of suspicion for cervical spine injury in pediatric maxillofacial fracture cases. • Improper examination and manipulation to the head and neck region could cause serious injuries to the spinal cord leading to devastating outcomes in the young child. • Multidisciplinary team management is important in concomitant maxillofacial and cervical spine injuries for safe and optimal outcome.