Circummandibular Wiring Research Articles

Pengelolaan Fraktur Dentoalveolar pada Anak-Anak dengan Cap Splint Akrilik

Tujuan perawatan fraktur pada anak-anak pada dasarnya sama dengan orang dewasa, tetapi dengan managemen yang berbeda, dimana perkembangan rahang dan gigi geligi menjadi pertimbangan utama dalam pemilihan metoda perawatan. Melaporkan dua kasus fraktur dentoalveolar pada anak dibawah 5 tahun yang dirawat dengan menggunakan cap splint akrilik dengan sirkum mandibular wiring dengan anastesi umum. Dua orang anak, umur 1 tahun dan 3 tahun datang dengan rujukan ke unit gawat darurat RSS dengan diagnosa fraktur dentoalveolar, pada kedua kasus dilakukan perawatan menggunakan caps splint dengan fiksasi menggunakan sirkum mandibular wiring dengan anastesi umum. Setelah 3 minggu cap splint akrilik dan sirkum mandibular wiring di lepas dengan sedasi. Pada daerah fraktur tidak di jumpai kegoyahan. Kontrol minggu ke 6, gigi stabil tanpa kegoyahan, oklusi normal, tidak terdapat infeksi. Cap splint akrilik dengan sirkum mandibular wiring adalah salah satu metode pilihan yang simpel, efektif dengan invasif minimal yang dapat digunakan sebagai pilihan untuk perawatan kasus fraktur dentoalveolar pada anak.Management of Dentoalveolar Fractures in Children Using Acrylic Cap Splint. The purpose of fracture treatment in children is basically the same as that in adults with different management, while the choice of treatment method mainly relies on the development of jaws and teeth. It reports two cases of dentoalveolar fractures in children under 5 years old who were treated using acrylic cap splint with circum-mandibular wiring under general anesthetic. Two children, aged 1 year and 3 years old were referred to the emergency department of Dr. Sardjito Hospital with the diagnosis of dentoalveolar fractures. Both cases were treated using cap splint with circum-mandibular wiring-based fixation under general anesthetic. After 3 weeks, the acrylic cap splint and the circum-mandibular wiring were released under sedation. No loose teeth were found in the fracture area. In the following 6 weeks, the teeth were stable with normal occlusion and no infection found. Acrylic cap splint with circum-mandibular wiring is a simple, effective and minimally invasive method for dentoalveolar treatment in children.

Management of Mandibular Body Fractures in Pediatric Patients: A Case Report with Review of Literature

Mandibular fractures are relatively less frequent in children when compared to adults, which may be due to the child's protected anatomic features and infrequent exposure of children to alcohol related traffic accidents. Treatment principles of mandibular fractures differ from that of adults due to concerns regarding mandibular growth and development of dentition. A case of a 7 year old boy with fractured left body of mandible managed by closed reduction using open occlusal acrylic splint and circummandibular wiring is presented. Patient was reviewed on regular intervals, the circum-mandibular wiring and splint was removed after 15 days under local anesthesia. No mobility was present at the fracture site. Postoperative recovery was uneventful and satisfactory occlusion was achieved. Patient had good masticatory efficiency.

Pediatric mandibular fracture: An unusual etiology

IntroductionMandibular fractures in children are rare and different from adults in terms of etiology, epidemiology, treatment considerations and associated complications. Thick adipose tissue, elasticity of the bone and protective nature of the parents have a protective influence on the prevalence of mandibular fractures in pediatric age group. However, lack of education may be a factor influencing the etiology of such injuries as shown in the present case. Case reportThe present case report describes a rare case of mandibular fracture inflicted unintentionally by his mother in an 18 month old child during drinking of water directly from the tap in his mouth. The fracture was treated conservatively using custom-made cap splint and circum-mandibular wiring. ConclusionThe purpose of this case report is to motivate pediatric dentists that parents coming to them for treatment of their children should not only be educated regarding the care of teeth and gums, but should take care of the oral cavity as a whole. Also, through this paper it is stressed that supervision of the growing child is utmost important to avoid such injuries.

Repair of a Pediatric Bilateral Condylar and Symphyseal Fracture Using a Transfacial Steinman Pin

The proper management of complex pediatric mandibular fractures remains a topic of debate because of the relatively uncommon presentation of these fractures, combined with concerns related with deciduous teeth, tooth buds, and growth inhibition. In this current study, we present a novel approach to the repair of bilateral condylar fractures with concomitant symphyseal fracture in a 4-year-old girl. Manual closed reduction was first obtained, followed by placement of a transfacial Steinman pin through the angles of the mandible and placement of circummandibular wires. Maxillomandibular fixation remained for 2 weeks and the Steinman pin was removed after 11 weeks. At 3 months of postsurgical follow-up, the patient displayed class I occlusion, facial symmetry, full range of jaw motion, and absence of deviation or pain on full oral excursion. Radiographic findings also revealed complete resolution of the symphyseal fracture with appropriate condylar healing and alignment.

Lateral compression splint, a guide for stabilization of mandibular arch in case of dentoalveolar fracture of children

Children (below 13 yrs of age) are usually susceptible to cranio facial trauma because of their greater cranial mass to body ratio. When compared to adults, the pattern of fractures and frequency of associated injuries are similar but the overall incidence is much lower. Treatment is usually performed without delay and can be limited to observation or closed reduction in non-displaced or minimally displaced fractures. Operative management should involve minimal manipulation and may be modified by the stage of skeletal and dental development. Open reduction and rigid internal fixation is indicated for severely displaced fractures. When tooth buds within the mandible do not allow internal fixation with plates and screws, this can be achieved with a mandibular compression splint fixed to the teeth, to the mandible with circum-mandibular wire. Children require long-term follow-up to monitor potential growth abnormalities. A case of a 9-year-old boy with fractured body of mandible managed by closed reduction using occlusal acrylic splint and circum mandibular wiring is presented. DOI: http://dx.doi.org/10.3329/updcj.v3i2.18001 Update Dent. Coll. j: 2013; 3 (2): 55-60

Comprehensive management of pediatric mandibular fracture caused by an unusual etiology

Mandibular fractures in children are rare due to thick adipose tissue, resiliency of bone and protective and care taking nature of the parents. These fractures carry different etiology and treatment considerations with them when compared with similar types of injuries in adults. Furthermore, the associated complications may have long lasting effect on the growth and development of the child's face and developing teeth. The purpose of this case report is to highlight the occurrence of mandibular fracture in 7-year-old caused by horse-kick and its subsequent management by open cap-splint with circum-mandibular wiring.

Use of a Mandibular Plate to Maintain Intergonial Width in a Partially Edentulous Patient Undergoing Mandibular Symphysis Reconstruction

One of the most challenging and essential aspects of management of patients with traumatic or ablative deformities involving the mandibular symphysis is maintenance of intergonial width. Classically, the use of occlusal splints has been a simple and cost-effective solution to this problem. Patients who are edentulous, the use of Gunning splints with circummandibular wires is an alternative strategy. In the present report, we describe the use of a mandibular fixation plate for maintenance of intergonial width in an edentulous patient with a postablative mandibular symphysis defect.

Lateral compression open cap splint with circummandibular wiring for management of pediatric mandibular fractures: a retrospective audit of 10 cases

Mandibular fractures are relatively less frequent in children when compared to adults. Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning and in their functional needs. We currently describe our experience with lateral compression open cap splint with circummandibular wiring as a treatment modality which involves fewer risks in treating pediatric symphysis/parasymphysis/body mandibular fractures. A retrospective analysis of pediatric patients with mandibular symphysis/parasymphysis/body fractures operated from January 2007 to January 2012 was performed. Clinical photographs and orthopantomogram assessment at the time of presentation, after treatment, and at 6 months postoperatively were evaluated. All the 10 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 one patient developed infection at submental region. The 6-month follow-up showed good occlusion, without interference in teeth eruption and no signs of temporomandibular joint problems. Lateral compression open cap splints for treatment of pediatric mandibular symphysis/parasymphysis/body fractures are reliable treatment modalities with regard to occlusion-guided fracture reduction.

Open reduction and internal fixation of mandibular fracture in an 11-month-old infant: a case report

Mandibular fractures in infants are rare. This case report describes management of a mandibular fracture in an 11-month-old infant using a microplate and screws with open reduction. The surgical treatment was successful. Because the bone fragments were displaced and only the primary incisors had erupted, conservative treatment, such as an acrylic splint and circummandibular wiring, was not recommended. Nine weeks after surgery, the microplate was removed. The results showed complete clinical and radiological bone healing with normal eruption of deciduous teeth.

Circummandibular Wiring of Symphysis Fracture in a Five-Year-Old Child

The treatment of pediatric maxillofacial fractures is unique due to the psychological, physiological, developmental, and anatomical characteristics of children. Method. This case report describes the management of symphysis fracture of mandible in a 5-year-old boy. The fracture was treated by acrylic splint with circummandibular wiring. Results. The splint was removed after 3 weeks. The patient had no complaints, and radiograph revealed a healed fracture. Conclusion. The clinical outcome in the present case indicates the management of mandibular fractures in pediatric patients using acrylic splint with circummandibular wiring.

Circummandibular wiring made easy: A case report

Mandibular fractures are less common in children as compared to adults. The treatment plan in children has to be modified as compared to adults considering the presence of tooth buds and potential disturbances in growth. Use of acrylic splints has been one of the popular techniques in children because of its relatively easy placement and reduced risk of hindrances to growth of jaw. These splints have been traditionally been fixed with the help of cements and circummandibular wires. We describe the use of intravenous cannula stilete instead of traditional bone awl to secure the splint in place.

Optimizing Pediatric Interdental Fixation by Use of a Paramedian Palatal Fixation Site

Condylar fractures are the most common injury seen in pediatric mandibular trauma. These injuries often cannot be adequately stabilized by conservative techniques such as splinting. The pediatric condyle fracture often requires a period of intermaxillary fixation. Because of the characteristics of the developing dentition, circumdental wiring is often not possible. Surgeons commonly achieve interdental stabilization by the connection of a circum-mandibular wire and a second wire placed through a drill hole in the piriform aperture. This method can be problematic in the young patient whose palatal suture is still patent. In this brief technical note, the use of a paramedian drill hole through the palate posterior to the maxillary incisors is described. It is believed that this method is superior to other techniques because it avoids injury to the deciduous tooth buds and allows for the maxillary wire to be seated in more structurally sound tissues.

Circummandibular wiring: An absolute answer to paediatric maxillofacial trauma: An unusual case report

On an average the incidence of pediatric maxillofacial injuries accounts for 4-6% of cases. Operative management should involve minimal manipulation and may be modified by the stage of skeletal and dental development. The goal of treatment of these fractures is to restore the underlying bony architecture to pre-injury position, in a stable fashion, as non-invasively as possible, and with minimal residual esthetic and functional impairment. The purpose of this article is to provide an insight on maxillofacial injuries in pediatric patient and to assist the clinician in the management of mandibular parasymphysis fracture in children with occlusal acrylic splint fixed with circummandibular wiring, a definitive treatment modality.

Open cap splint with circummandibular wiring for management of pediatric mandibular parasymphysis/symphysis fracture as a definitive treatment modality; a case series

Management of pediatric maxillofacial injuries is mainly governed by their psychological, physiological, developmental, and anatomical characteristics. Pediatric mandibular fractures can have variable etiologies but have similar manifestations as those in adult patients. There are various treatment modalities to treat mandibular parasymphysis/symphysis fractures in children, which have their own limitations and complications. We currently describe our experience with open cap splint as a treatment modality which involves fewer risks in treating 10 pediatric parasymphysis/symphysis mandibular fractures.

CIRCUMMANDIBULAR WIRING IN PEDIATRIC MAXILLOFACIAL TRAUMA: A CASE REPORT.

Fractures in children are relatively uncommon due to high resiliency of bone. Mandibular fractures are most frequently fractured facial bone in pediatric patients after nasal bones. Construction of acrylic cap splints and retaining them over the fractured mandible with circummandibular wiring is ideal in such cases. Highly displaced fractures may require monocortical screws with plate fixation at inferior border of mandible to avoid damage to underlying teeth. One such case of displaced fractured mandible with circummandibular wiring and open reduction and internal fixation is presented here.

Versatility of circummandibular wire as a tool for closed reduction of mandibular fractures

Versatility of circummandibular wire as a tool for closed reduction of mandibular fractures

Pediatric Maxillary Fractures

Pediatric craniofacial structures differ from those of adults in many ways. Because of these differences, management of pediatric craniofacial fractures is not the same as those in adults. The most important differences that have clinical relevance are the mechanical properties, craniofacial anatomy, healing capacity, and dental morphology. This article will review these key differences and the management of pediatric maxillary fractures. From the mechanical properties' perspective, pediatric bones are much more resilient than adult bones; as such, they undergo plastic deformation and ductile failure. From the gross anatomic perspective, the relative proportion of the cranial to facial structures is much larger for the pediatric patients and the sinuses are not yet developed. The differences related to dentition and dental development are more conical crowns, larger interdental spaces, and presence of permanent tooth buds in the pediatric population. The fracture pattern, as a result of all the above, does not follow the classic Le Fort types. The maxillomandibular fixation may require circum-mandibular wires, drop wires, or Ivy loops. Interfragmentary ligatures using absorbable sutures play a much greater role in these patients. The use of plates and screws should take into consideration the future development with respect to growth centers and the location of the permanent tooth buds. Pediatric maxillary fractures are not common, require different treatments, and enjoy better long-term outcomes.

Lingual Arch Bar Application for Treatment of Rostral Mandibular Body Fractures in Cats

To describe a lingual arch bar technique for fixation of rostral mandibular body fractures and report outcome in 16 cats. Original study. Cats (n=16) with rostral mandibular body fracture (10 bilateral, 6 unilateral) just caudal to the canine teeth. Orthodontic wire (Dentaurum® ; 0.9 mm) was used as a lingual arch bar by contouring it to the shape of the lingual side of the alveolar margin, and secured by circum-mandibular wires passed interproximal to teeth. Stability of fixation, occlusion, tolerance to the lingual arch bar, degree of secondary gingivitis/periodontitis, and ability to eat were evaluated clinically, and fracture union was assessed radiographically. The lingual arch bar was well tolerated. Eleven cats without a feeding tube were able to eat within 24 hours. Time to fracture union and appliance removal ranged from 28 to 64 days (mean, 42.5 days). Malocclusion of the rostral part of the fracture occurred in 5 cats; however only 1 required correction. Intraoral stabilization of rostral mandibular fractures using a lingual arch bar is a simple and effective method for the treatment of rostral mandibular fractures just caudal to the canine teeth.

A conservative approach to pediatric mandibular fracture management: Outcome and advantages

Pediatric mandibular fractures are rare and their treatment remains controversial. Management is extremely complicated in mixed dentition as it is inherently dynamic and unstable. Treatment options include soft diet, intermaxillary fixation with eyelet wires, arch bars, circummandibular wiring, or stents. Alternative options include open reduction and internal fixation through either an intraoral or extraoral approach. This case report describes and evaluates the conservative technique of acrylic splint in the treatment of pediatric mandible fracture in a 12-year-old female child. The patient with isolated mandibular fracture was treated with acrylic splint and interdental wiring followed by evaluation of clinical and radiographic healing as well as the somatosensory status. Patient demonstrated clinical union to her pre-injury occlusion by three to four weeks. Panoramic finding supported the finding of clinical examination throughout the study. High osteogenic potential of the pediatric mandible allowed conservative management to be successful in this case.

Mandibular fracture in an 18-month-old child

Facial trauma in a child can be a greatly distressing experience for the parents as well as the child, causing uncontrollable crying in the child and panic and fear in the parents. Facial injuries in children are less common than in adults. This case report describes the management of symphysial fracture of the mandible in an 18-month-old girl. The fracture was reduced under general anesthesia and then stabilized with an acrylic cap splint, utilizing circummandibular wiring.