Circummandibular Wiring Research Articles

Pediatric Mandibular Fracture Management: Intraoperative Thermoplastic Splint Fabrication and Circummandibular Wires, without Maxillomandibular Fixation

Summary: Management of mandibular fractures often involves the use of maxillomandibular fixation (MMF) to attain immobility of the fractured segments. This can be used as a primary treatment modality or as an adjunct in fracture management. This technique, however, has its drawbacks due to the great burden of care imposed on patients. In the following case, fixation of a pediatric open mandibular body fracture was attained without the use of MMF, and bone union was achieved. Due to age, safety concerns, long-distance travel, and parent’s preference, the routine management of this type of fracture with MMF using piriform aperture drop wires and circummandibular wires was not done. Instead, the fracture was reduced, and an intraoral mandibular impression was taken in the operating room, which was used to create a stone model. A 2-mm acrylic splint was designed and fabricated from the stone model, and two circummandibular wires were placed. The wires were tightened over the acrylic splint to achieve stabilization of the mandibular reduction. At 4 weeks postoperatively, the splint was removed, and the patient was maintained on a soft diet. At 6 weeks, bone union was appreciated clinically by immobility of the mandibular segments, and the patient was advanced to a regular diet. Occlusion was corrected to premorbid state by clinical findings and 6 months postoperative imaging. This technique represents an effective approach in managing pediatric mandibular fractures when MMF cannot be used.

Mandibular Fracture in a Newborn From Birth Trauma: A Case Report

Objective: To report a case of mandibular fracture in a newborn presenting with post-delivery oral cavity bleeding and to discuss its etiology, clinical findings, diagnosis, management and outcome after treatment. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A newborn girl was referred for oral cavity bleeding after partial breech extraction. An intraoral hematoma and symphyseal step deformity on examination corresponded to a complete fracture of the symphysis and downward displacement of the left hemimandible on facial CT scans with 3D reconstruction. An uneventful closed reduction with external fixation using acrylic cap splint with circum-mandibular wiring was performed under general anesthesia and she was discharged feeding well. The cap splint and wires were removed after 4 weeks showing good facial symmetry and bone alignment. There were no complications on follow-up after 1 year. Conclusion: Mandibular fracture can result from traumatic delivery and present with oral bleeding and hematoma. A thorough physical examination and workup should be done to assess for the sites involved. A multidisciplinary approach should be undertaken to provide the best possible care with the least invasive technique.

Management of a pediatric mandibular symphysis fracture with a custom acrylic cap splint

ABSTRACT Traumatic dentoalveolar injuries in pediatric patients are a common occurrence. Treatment strategies for managing mandibular fractures in pediatric patients are dissimilar to that of adult patients. The dynamic nature of bone, developing tooth buds, parent’s levels of apprehension, and the patient’s level of cooperation are some of the factors which dictate the treatment of choice. Treatment rendered should aim at the stabilization of fractured segments with minimum invasiveness. The purpose of this case report is to describe the management of mandibular symphysis fracture in a 1-year-old boy using an acrylic splint which is stabilized with circummandibular wiring.

Multimodal Approach for Pediatric Mandibular Fractures: A Case Series

Background The management of facial fractures varies due to a variety of reasons in the pediatric age groups. The clinicians should therefore attune themselves to managing pediatric patients and the variations thereof. Every modality mentioned in the literature has its own advantages and disadvantages. The right choice of treatment by clinicians depends on their knowledge of pediatric anatomy, physiology, age-dependent bone growth, and the type and extent of fractures. Three different modalities of treatment in the form of circummandibular wiring, intermaxillary fixation and open reduction, with internal fixation were rendered to the patients, considering various factors such as the patient’s age, location of the fracture line, status of occlusion, and dentition. All three modalities showed good results in the form of adequate reduction and no post-op complications. Conclusion Pediatric trauma is a challenging entity for the surgeon. The choice of the ideal treatment modality ultimately depends on the presence of tooth buds and the maintenance of uninterrupted growth of the jaw bone. Thus, a well-thought-out and customized treatment plan should be devised for each individual case.

Prefabricated Acrylic Cap Splint: A Minimally Invasive and Conservative Intervention for Paediatric Mandibular Fractures: A Case Report

Dental traumatic injuries in paediatric patients result in a painful experience for both the parents and the child. Although children may exhibit similar fracture patterns as seen in adult traumatic injuries, there are various factors to consider when treating fractures in paediatric patients, which pose challenges for paediatric dentists. There are numerous treatment options available for managing maxillofacial fractures, such as open reduction, closed reduction, immobilisation with open or closed cap splint, with or without circummandibular wiring, and the use of mini plates, among others. In this present case report, a five-year-old child presented with multiple step deformities in the mandible. Since the patient had deciduous dentition, the main concerns were the high possibility of disruption to the periosteal envelope, which could affect the growth of the mandibular processes, and damage to developing permanent tooth buds. These were key considerations when planning the appropriate treatment. Taking into account these potential complications associated with other invasive procedures, a minimally invasive conservative management approach was chosen for the child, which proved to be highly successful and cost-effective. Undisplaced fractures in paediatric patients should always be treated or stabilised using the closed reduction method.

Prevalence of paediatric maxillo-facial trauma in India: a single centre, 5-year retrospective study

Background: Trauma is one of the most common reasons of fatalities worldwide. A study on the prevalence is important to know about the common causes of trauma. Such studies and data boost the campaigning on prevention and increasing awareness against trauma.Methods: Traumatised patients who reported to the emergency or casualty department of Mahatma Gandhi hospital, Sitapura, Jaipur or out-patient department of department of oral and maxillofacial surgery of Mahatma Gandhi Dental college and hospital, Sitapura, Jaipur between January 2017 and December 2021 were selected for this study. The hospital records of patients were retrospectively analysed for age, gender, etiology of trauma, distribution of fracture in facial structure and among maxilla and mandible, treatment procedures patients underwent in different age groups.Results: 371 traumatic patients were analysed for paediatric maxillofacial trauma. The commonly affected age group were found to be 13-16 years, with road traffic accidents being the most common etiology leading to mandible green stick fracture with dentoalveolar and Lefort II fracture in majority of cases. The frequent treatment option was found to be either conservative management, circummandibular wiring, splinting or Open Reduction and Internal Fixation according to age groups.Conclusions: The facial injury pattern is influenced by growth and age of patient. The effect and the management of trauma depend on the age of child. Road traffic accident are the most common cause of trauma and mandible bone is the most frequently fractured bone with dentoalveolar fracture during facial injuries. A clear male predilection has also been observed.

Nine Years of Retrospective Study of Mandibular Fractures in Semi-urban Teaching Hospital, Shimla, Himachal Pradesh, India.

Retrospective study. To evaluate current trends in maxillofacial trauma, a retrospective study of mandibular fractures at Government Dental College and Hospital Shimla H.P was carried out. In this retrospective study, records of 910 patients with mandibular fractures were reviewed between 2007 and 2015 in the Department of Oral and Maxillofacial Surgery out of total 1656 facial fractures. These mandibular fractures were assessed according to age, sex, aetiology in addition to monthly and yearly distribution. Post-operative complications such as malocclusion, neurosensory disturbances and infection were recorded. It was observed that mandibular fractures were most frequent in males (67.5%) and in the age group of 21-30years; accidental fall was the most common etiological factor (43.8%) in the present study and in stark difference to already published reports. The most common fracture site was that of condylar region 239 (26.2%). Open reduction and internal fixation (ORIF) were done in 67.3% cases whereas 32.6% were managed by maxillomandibular fixation and circummandibular wiring. Miniplate osteosynthesis was the most favoured technique. The complication with ORIF was 16%. To treat mandibular fractures, currently there are many techniques. However, in minimizing complications and in achieving satisfactory functional and aesthetic results experienced surgical team plays an important role.

Novel and Affordable Low-Cost Technique for Fixation of Parasymphyseal Fractures in Infants With Unerupted Dentition

Pediatric mandibular fractures are immensely challenging compared to adult fractures. The current update management spectrum ranges from the conservative one in the form of soft diet and regular follow-up, or less invasive surgical intervention by closed reduction and nonrigid fixation, to open reduction and internal fixation with plates and screws. In this study, we investigated the use of a straightforward fabricated mold for the parasymphyseal mandibular fracture in infants with an unerupted dentition. This prospective study was conducted on 8 infants presenting with parasymphyseal fractures with unerupted dentitions in our specialized trauma center. In the operating room before the induction of anesthesia, the authors used a straightforward plastic airway to create a splint. The curved part was split into 2 transverse halves making 2 U-shaped curved pieces that were utilized as a mold. Intraoperatively, the U-shaped piece was placed over the mandible and stabilized with circummandibular wires. This molded airway is used to stabilize the fracture site for 2-3weeks. The average period of follow-up was around 6months. The average time of mandibular fixation was 17.6±2.4 SD (14 to 20) days. The mean of the total operative time was 38.7±3.5 SD minutes, ranging from 35 to 45minutes. Our infants were observed in the outpatient clinic for 6months postoperatively during the follow-up period. There were no noticeable complications nor any interference with tooth eruption or mandibular growth. The results of this study suggest that this technique is straightforward to use and affordable. It does not require a long learning period. It also exhibits the advantage of reducing the cost in many developing countries.

Management of Pediatric Maxillofacial Trauma Using Acrylic Cap Splint Followed by Circummandibular Wiring: A Single Centric Study

Introduction: Facial fractures in children account for 15% of all facial fractures in the general population. Children are more likely to have mandibular fractures than midface fractures, with condylar fractures being the most prevalent, followed by parasymphysis, angle, and body fractures. The low prevalence of mandibular fractures in children can be linked to the safe environment they are provided with as well as their unique growing patterns. Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning and in their functional needs. Materials and Methods: A prospective analysis of pediatric patients with mandibular symphysis/parasymphysis/body fractures operated from January 2016 to October 2021 was performed. Clinical photographs and orthopantomogram assessment at the time of presentation, after treatment, and at 6 months postoperatively were evaluated. Result: All 17 patients were followed up until the period of 6 months, and none of them had any major complications. Postoperatively, there was satisfactory healing and union of fracture fragments in all the patients. Only 1 patient developed an infection in the submental region. In each case, the surgical splint was removed during 15 to 21 postoperative days. The 6-month follow-up showed good occlusion, without interference in teeth eruption, and no signs of temporomandibular joint problems. Conclusions: In our study, because of the sheer ease of fabrication, maintenance of periodontal tissue integrity, patient compliance, and convenience of measuring the occlusion following reduction, we chose an acrylic cap splint followed by circummandibular wiring.

Epidemiology of Maxillofacial Fracture – A Hospital Based Study

Introduction: Maxillofacial trauma is the most common problem seen by maxillofacial surgeons in Nepal. The causes of facial fractures are road traffic accidents (RTA), assaults, falls, gunshot wounds, domestic violence, sports and work injuries. Maxillofacial injury varies from soft tissue injury to facial bone fractures. This study was conducted to assess the burden of maxillofacial trauma in mid-western and far-western regions of Nepal.
 Material and Method: Patients with maxillofacial fractures admitted in dental ward of NGMCTH, Kohalpur, from April 2017 to April 2019 were included in the study. Patients having soft tissue injury without facial bone fractures and OPD cases were excluded from the study. Patient demographics, mechanism of injury, associated soft tissue injury, accompanying injuries to other parts of body and facial bone fractures were recorded. Patient were treated by open reduction internal fixation or lateral compression splint with circum-mandibular wiring or managed conservatively as necessary.
 Result: A total of 87 patients were included in the study. The age of patient ranged from 2 years to 67 years with a mean of 26.87 years. Most of the injuries occurred between the age group of 20-29 years with male: female ratio 5.2:1. The most frequent cause of facial bone fracture was RTA (51.7%) and the most frequently fractured facial bone was mandible. Contusion 54(49.5%) was the most common associated soft tissue injury. Head injury 20(52.6%) was the most common accompanying injury to other parts of body. The mean duration of hospital stay was 6.29.
 Conclusion: Male patient in their third decade mostly had mandible fracture due to road traffic accident. Head injury was the most common accompanying injury. Contusion was the most common type of associated soft tissue injury.

Management of Mandibular Body Fracture in an Eighteen-Month Old Child - A Case Report

With the advancement of the transportation system and improvement in road conditions, the number of high- velocity accidents has also increased. Almost all of these reported cases involve individuals who had travelled in vehicles without adhering to personal protection standards and with rash driving. Injuries to the facial region can be profoundly disturbing and particularly in children. Parents find it very distressing to see their child in pain with a disfigured or injured face. It is difficult to manage such crying & sometimes uncontrollable children. The most commonly injured facial bones are Nasal, Zygomatic and the Mandible. The incidence of facial bone fracture in children is uncommon, and we present a case report of an 18- month old child with a history of road traffic accident and swelling on the right side of the face. Intraoral examination shows limited mouth opening with submucosal ecchymosis in the right buccal mucosa and based on clinical and computed tomographic scan working diagnosis of fracture in the right body of the mandible was arrived. The child was surgically treated with the circum-mandibular wiring. After three weeks the splint was removed. The injury healed without complications in the post-operative period.

Study of Different Sites of Fractures of Mandible in Andrapradesh Population

96 patients (78 males and 18 females) aged between 18 to 45 years had fractures of mandible-62(64.5%) had road accident, 17(17.7%) had assault, 12(12.5%) sports injury, 5(5.2%) due to falls. The anatomical sites of fractures were 32(33.3%) had symphysis menti and parasymphysis, 15(15.6%) had body of mandible, 13 (13.5%) had angle, 10(10.4%) had ramus, 7(7.29%) had condyles, 19(19.7%) had alveolar fractures. 46(47.9%) had isolated fractures and 50(52.0%) had multiple fractures. Types of treatment method were 3(3.1%) were un-treated, 19(19.7%) had IMF (inter maxillary fixation 5(5.2%) had circummandibular wire with an occlusal splint, 9(9.3%) had Risdon wining 46(47.9%) had MPO= mini plate osteo synthesis. 14(14.5%) had reconstruction plates. This study will be quite use full to oral and maxilla facial surgeon because morpho metric study of mesoderm is un-certain

Infantile Mandibular Fracture Treatment with Double-crossed Skeletal and Circummandibular Wires: A Case Report

Abstract The prevalence of mandibular fracture is relatively lower in the pediatric population compared to adults. The treatment of these fractures is more challenging for oral and maxillofacial surgeons due to the concerns regarding mandible growth and the presence of developing tooth buds. According to the literature, conventional methods (e.g., soft diets or closed reduction) are more effective in the treatment of nondisplaced pediatric mandibular fractures. There are few case reports regarding the treatment of mandibular fractures in infants, which have mainly introduced new technique using double-crossed direct skeletal wires to reinforce circummandibular wirings for the conservative treatment of infantile mandibular fractures. The present study aimed to describe the case of a 12-month male infant with significant dislocated right mandibular parasymphysis fracture. Initially, two circummandibular wires were passed bilaterally to pull the mandibular segments for their vertical alignment. Afterwards, the skeletal buccal and lingual direct wires reinforced the previous circummandibular wiring to fit the fracture segments. Finally, all the wires were tightened simultaneously to maintain satisfactory bone reduction. Furthermore, the addition of skeletal buccal and lingual direct wires could reinforce the previous circummandibular wiring to fit the fracture segments anteroposteriorly. The fracture healed uneventfully with no complications, and intermaxillary fixation was not required in the patient. Moreover, the alveolar segments were in an appropriate position, and the maximum mouth opening of the patient was normal with no deviation, indicating a successful clinical outcome. This method was relatively reliable, noninvasive, and inexpensive, associated with the decreased discomfort and morbidity associated with maxillomandibular fixation, open reduction, and internal fixation in infants.

A Simplified Digital Workflow for the Treatment of Pediatric Mandibular Fractures Using Three-Dimensional (3D) Printed Cap Splint: A Case Report

Pediatric mandibular fracture needs special consideration by clinicians. The management of pediatric mandibular fracture differs from that in adults considering the presence of tooth germs and the potential for mandibular growth. One of the most common forms of conservative management for pediatric mandibular fractures is the use of cap splint along with circummandibular wiring. The conventional workflow prior to performing surgery with this technique is impression taking and dental model fabrication. Additionally, it is also recommended that mock surgery should be performed to achieve proper reduction before acrylic splint fabrication. However, these procedures are effortful and time consuming when performed under general anesthesia during surgery and require additional sedation if performed prior to surgery. The aim of this case report is to describe a simpler preoperative digital workflow for the treatment of pediatric mandibular fractures, in which closed reduction is achieved with a three-dimensional printed cap splint stabilized with circummandibular wiring under general anesthesia.

Retrospective Study of Facial Fractures.

Aim:The aim of this study was to give an insight into the retrospective analysis of a number of maxillofacial trauma cases reported to our institute and research center.Materials and Methods:The data for this study was obtained from the medical records and outpatient prescription slips of cases treated at the Oral and Maxillofacial Surgery Department from 2010 to 2016. Etiology, age, gender, pattern of fracture, and surgical treatment modalities undertaken in these patients were recorded.Results:A total of 353 maxillofacial trauma patients with mean age of 40 years, treated at our institute were evaluated from 2010 to 2016. Mandible was the most commonly fractured bone with parasymphysis as the most frequent site. Majority of victims were males (male:female ratio of 4:1) and also in the third decade of life. This study showed that 73% patients were treated by open reduction and internal fixation (ORIF), 25.8% by intermaxillary fixation (IMF) and Stabilization of fracture mandible with acrylic splint and circummandibular wiring was done in 0.8% pediatric patients.Conclusion:It was concluded that road traffic accidents were reported as the leading cause of maxillofacial fractures followed by assault, falls, and familial dispute. Maxillofacial surgeons as health care providers must continue their ‘face it’ campaign to decrease the incidence of road traffic accidents. Open reduction and internal fixation remains the gold standard treatment modality.

Management of Mandibular Fractures in Pediatric Patients With Conservative Technique: A Case Series

The management of fractures in children is complex compared to that of adults because of greater elasticity of bone, presence of tooth buds, faster healing rate, potential for future growth and lesser co-operative ability. Fractures of the mandible in children are conventionally treated by circummandibular wiring. This paper reports a variation in the technique of using circummandibular wiring with acrylic splints in the conservative treatment of mandibular fractures in two pediatric patients.

Circummandibular Wiring: A Treatment Approach toward Management of Mandibular Fracture in Children

ABSTRACTUnderstanding the repercussions of facial trauma on subsequent growth and the aftermath of the various methods of treating pediatric facial fractures is not something that those who treat adults have to take into account. Young bone possesses unique physical properties that coupled with the space-occupying developing dentition give rise to patterns of fracture not seen in adults. This results in a need for different forms of fixation for shorter periods of time. This case report documents trauma and follow-up care of a 4-year-old patient with mandibular fracture.How to cite this articleKumar N, Kumar A, Syreen S, Singh S. Circummandibular Wiring: A Treatment Approach toward Management of Mandibular Fracture in Children. Int J Clin Dent Res 2017;1(1):37-39.

Mandibular fracture in a neonate

Mandibular fractures in the neonate are rare. The aetiological factors are traumatic delivery, accidental fall, road traffic accidents, and attempted infanticide. The diagnosis is difficult due to facial oedema masking the clinical features and the absence of dentition. The treatment of fractures in the newborn represents a unique problem in terms of investigations, diagnosis, selection of anaesthesia, and method of fixation. The case of a 1-day-old infant referred for the management of a mandibular fracture sustained in an accidental fall is presented herein. During oral suctioning, the neonatologist observed continuous blood-stained secretions, which raised the suspicion of a trauma to the oral cavity. The infant was diagnosed as having a fracture of the mandibular symphysis with displacement. The fracture was reduced under local anaesthesia with sedation, and was stabilized with an acrylic splint, which was secured with circum-mandibular wiring. The patient was followed up for 1.5 years and the healing was satisfactory.

A Conservative Method for Treating Severely Displaced Pediatric Mandibular Fractures: An Effective Alternative Technique

Pediatric mandibular fractures have been successfully managed in various ways. The use of a lingual splint is an option. This article presents a 4-year old boy who was treated by an alternative conservative method with a combination of an arch bar plus a lingual splint, circum-mandibular wiring and IMF for the reduction, stabilization and fixation of a severely displaced bilateral man‌dibular body fracture. This technique is a reliable, noninvasive procedure; it also limits the discomfort and morbidity associated with maxillomandibular fixation or open reduction and internal fixation in pediatric patients

Mandibular fractures in different pediatric age groups and their current management modalities

Background: A number of cases of growing age trauma within oro-facial region have been observed in Pakistan, unlike developed countries of world. Mandibular fractures occur in greater frequency than those of the middle third of the face in children, later being very small and plastic comparative to mandible. These fractures of mandible do not demonstrate different clinical features as compared to adults but there is relative difference in treatment management due to, different patterns and plasticity of the facial bones in children, developing tooth buds at different levels in the jaws, mixed dentition, shedding deciduous teeth and incomplete roots of anterior teeth. The causes and patterns of fracture in children older than 12 years resemble to those found in adults. Mandibular fractures are common in Pakistan and commonly related etiology is accidental fall. Method: 57 patients presented with mandibular fractures at Oral and Maxillofacial Surgery department of Punjab Dental Hospital and Children Complex Hospital, Lahore from September 2003 to September 2005. The age of the patients ranged from infancy to early teenage (6 month to 15 years). After confirming diagnosis, the children were divided into following four groups; Group "A" (Infants), Group "B" (Pre-school), Group "C" (School) and Group "D" (Teenage). All patients were treated with one of the following treatment modalities, depending upon the site of fracture and age group of the patients; Micro and miniplates, Eric arch bar splints, Acrylic splints, Ivy eyelet wires, Trans-osseous wiring and Conservative treatment. Results: Group "A" of only 3 patients was managed with open reduction and microplate rigid fixation. Six months follow up showed healing without any complications. Group `B` with 60% males, had mostly body fractures, was treated with acrylic splints and circummandibular wires. Two bilateral body fractures, with avulsed few teeth, were fixed with rigid fixation. Five patients of about age 3 with minimally displaced body fractures were man aged with Eric arch bar fixation alone. Two bilateral condylar bowing fractures were treated conservatively (no active treatment) with no TMJ complications during follow up. The mandibular trauma was noticed exceedingly high in group `C` with overall 50.87% and exclusively in males (90%). Acrylic splints were utilized to treat either condyle with body fractures or condyles alone. Two children had postoperative ipsilateral jaw deviation on opening, which was improved with reverse elastic exercises during follow up. Five patients of high condylar fractures with either no or minimum occlusal disturbance, were conservatively managed. Early mobilization was the prime concern in them to avoid late complications. 17.54 % patients were of group `D` with again high male (90%) ratio. Two horizontally unfavorable angle fractures were managed by trans-osseous wires. Five with minimum displacement were managed with miniplates rigid fixation. All others` with associated condylar fractures were treated with Eric arch bar splint with one plate at body and intermaxillary fixation for two weeks. Conclusion: The patterns and management modalities of pediatric mandibular fractures vary in different age groups. The pediatric fractures should be managed as early as possible to avoid complications. Majority of trauma results in school going and teenage groups with definite high male proportion. High condylar fractures should be treated with extra care, keeping in mind of post traumatic TMJ ankylosis. Acrylic splints showed ideal results in body and condylar fractures, whereas, microplates may be the treatment of choice in infants with no or few deciduous teeth. No serious complications were observed during 6 months follow up.