Management Of Pediatric Mandibular Fractures Research Articles

ARMOUR IS HEAVY, YET IT IS A PROUD BURDEN- CAP SPLINT: A CASE SERIES

Traumatic injuries during childhood can have a considerable influence on the minds of growing children. For the purpose of supporting bony framework to pre-trauma condition, minimal manipulation of facial skeleton is necessary. In comparison to adults, the mandible in children have embedded tooth buds that hold the mandibular fragments together like a glue. Open reduction with rigid fixation is not recommended in fractures of the mandible in children. The goal of the treatment is restoration of the bony architecture in a stable position with a minimum malfunction and aesthetic disability. The purpose of the present case series is to demonstrate cap splint as a conservative and effective treatment modality for the management of pediatric mandibular fractures.

ARMOUR IS HEAVY, YET IT IS A PROUD BURDEN- CAP SPLINT: A CASE SERIES

Traumatic injuries during childhood can have a considerable influence on the minds of growing children. For the purpose of supporting bony framework to pre-trauma condition, minimal manipulation of facial skeleton is necessary. In comparison to adults, the mandible in children have embedded tooth buds that hold the mandibular fragments together like a glue. Open reduction with rigid fixation is not recommended in fractures of the mandible in children. The goal of the treatment is restoration of the bony architecture in a stable position with a minimum malfunction and aesthetic disability. The purpose of the present case series is to demonstrate cap splint as a conservative and effective treatment modality for the management of pediatric mandibular fractures.

Management of Pediatric Mandibular Fractures with Acrylic Splint and 26-gauge Stainless Steel Wire: A Case Series of 15 Cases and Review of Literature

Management of Pediatric Mandibular Fractures with Acrylic Splint and 26-gauge Stainless Steel Wire: A Case Series of 15 Cases and Review of Literature

Management of Pediatric Mandibular Fractures with Acrylic Splint and 26-gauge Stainless Steel Wire: A Case Series of 15 Cases and Review of Literature

Management of Pediatric Mandibular Fractures with Acrylic Splint and 26-gauge Stainless Steel Wire: A Case Series of 15 Cases and Review of Literature

Efficacy of open cap splint versus split acrylic splint in management of pediatric mandibular fractures

Objective: This prospective randomized clinical study was designed to evaluate the efficacy of open cap splint versus split acrylic splint in management of pediatric mandibular fractures. Patients and Methods: Twelve pediatric patients with symphysis, parasymphysis, and body of mandibular fractures treated by closed reduction and fixation were randomly selected. They were divided randomly into two equal groups: group (I) patients were treated by open cap splint and group (II) patients were treated by the split acrylic splint. Postoperative clinical ,and radiographic evaluations were performed to assess complications, occlusal stability, pain on a visual analogue scale (VAS), maximum mouth opening, and the overall results of fixation up to 6 months. Results: Fracture healing was optimal in all cases, except two cases in group I presented malunion of the fractured bone. Satisfactory dental occlusion was observed in all cases, except two cases in group I, where they had mild to moderate occlusal derangement. Other parameters including maximal mouth opening, and pain level were comparable. Postoperative radiographic evaluation showed a complete union of the fractured segments at the end of six months in all cases. Conclusion: The results of the current study showed that, the open cap splint and split cap splint provided enough stability for proper bone healing, establishment of optimal occlusion, and early return to normal function with superiority for split cap splint.

Management of pediatric mandibular fractures using bioresorbable plating system – Efficacy, stability, and clinical outcomes: Our experiences and literature review

AimsThe purpose of this study was to determine the efficacy and stability of the biodegradable fixation system for treatment of mandible fractures in pediatric patients by measuring the bite force. MethodsSixty pediatric patients with mandibular fractures (36 males, 24 females) were included in this study. The 2.5-mm resorbable plates were adapted along Champy's line of ideal osteosynthesis and secured with four 2.5mm diameter monocortical resorbable screws, 8mm in length. All patients were followed for 10 months. Clinical parameters, such as soft tissue infection, nonunion, malunion, implant exposure, malocclusion, nerve injury, and bite force for stability, were prospectively assessed. ResultsAdequate fixation and primary bone healing was achieved in 100% of the cases. Six minor complications (10%) were observed: 2 soft tissue infections (3%), 1 plate dehiscence (2%), 1 malocclusion (2%), and 2 paresthesia (3%). Conclusion2.5-mm resorbable plating system along Champy's line of ideal osteosynthesis is a good treatment modality for mandible fractures in pediatric patients.

An institutional experience in the management of pediatric mandibular fractures: A study of 74 cases

BackgroundIn maxillofacial surgery, children represent a special group of patients, as they have significant differences from adults as far as the facial skeleton is concerned. The etiology and epidemiology of pediatric trauma involving the facial skeleton has been reported in a large series of patients. Nevertheless, few of these reports review large numbers of pediatric patients, and little is known about treatment protocols for fractures in children. The aims of this study were to retrospectively analyze the treatment methods and outcomes of pediatric mandibular fractures in children and young adolescents up to the age of 15 years, to discuss the findings, and to propose treatment protocols for maxillofacial fractures in childhood. Materials and methodsThe present study retrospectively analyzed the treatment methods and outcome of the pediatric mandibular fractures in children and young adolescents' up to the age of 15 years over a period of 5 years. All patients were followed up for an average period of 18 months, with a maximum follow-up of 2 years. A total of 74 patients were treated for mandibular and dentoalveolar fractures in children upto the age of 15 years at the Department of Oral and Maxillofacial Surgery at Nair Hospital Dental College, Mumbai from 2007 to 2012. Resultsand Conclusions: The treatment methods used at our centre had satisfactory outcomes at the end of a follow-up period of 2 years. Reported complications were minimal. Our results confirm the usefulness of open reduction and plate fixation in older children (>12 years of age) and a conservative approach in younger children (≤12 years of age) in treating mandibular fractures.

Transosseous Fixation of Pediatric Displaced Mandibular Fractures With Polyglactin Resorbable Suture—A Simplified Technique

Management of pediatric mandibular fractures presents a unique challenge to surgeons in terms of its numerous variations compared to adults. Both conservative and open methods have been advocated with their obvious limitations and complications. However, conservative modalities may not be possible in grossly displaced fractures, which necessitate the open method of fixation. We present a novel and simplified technique of transosseous fixation of displaced pediatric mandibular fractures with polyglactin resorbable suture, which provides adequate stability without any interference with tooth buds and which is easy to master.

A method for direct fabrication of a lingual splint for management of pediatric mandibular fractures.

Pediatric mandibular fractures have successfully been managed in various ways. The use of a lingual splint is one such option. The typical indirect method for acrylic lingual splint fabrication involves obtaining dental impressions. Dental models are produced from those impressions so that model surgery may be performed. The splint is then made on those models using resin powder and liquid monomer in a wet laboratory and transferred to the patient. Obvious limitations to this technique exist for both patient and operator. We present a technique for direct, intraoperative, fabrication of a splint using commercially available light-cured material that avoids some of the shortcomings of the indirect method. Recommendations are made based on available material safety information.

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.

The Pediatric Mandible: I. A Primer on Growth and Development

After studying this article, the participant should be able to: 1. Describe embryonic and fetal mandibular development. 2. Summarize the aggregate changes in mandibular form from birth to puberty. 3. Describe the eruption and maturation of the deciduous and permanent mandibular dentition. In this, the first of two articles addressing the surgical management of pediatric mandibular fractures, the authors provide a detailed discussion of mandibular development and anatomy during the fetal period, infancy, and childhood. A review of the pertinent literature was performed. The changing structure of the developing mandible is discussed, with particular attention to surgically relevant anatomical structures. Throughout development, key anatomical structures with relevance to surgical therapy change markedly in position. The mandible undergoes significant change in its bony structure and the composition of its surrounding soft tissues. The mandible's bony structure becomes more robust, with an increasingly acute gonial angle and enlargement of the ramus and body. Furthermore, the mandible provides the bony structure from which tooth buds erupt as the deciduous and permanent dentition--a process that generates significant growth of the alveolar process. As a consequence, the distance between the developing dentition and the inferior mandibular border increases. While the canal of the inferior alveolar nerve undergoes significant superior displacement, the mental foramen becomes positioned more posteriorly over time. In addition, the ligamentous and muscular attachments that surround the temporomandibular joint become increasingly robust. Throughout childhood and adolescence, the blood supply of the mandibular body changes little, with the buccal periosteal plexus and inferior dental artery making significant contributions. Mandibular growth provides the basis for normal occlusal relations and the generation of increasingly large masticatory force. Although the exact mechanisms of bone remodeling during mandibular development remain unclear, the process likely receives contributions from primary growth centers and the response to local alterations in biomechanical force produced by surrounding soft-tissue structures. A working knowledge of the changing mandibular anatomy is a prerequisite for effective clinical management of traumatic injury.

Pediatric mandibular fractures.

Over the last 20 years, a revolution in the management of facial fractures has taken place. Refinements in biocompatible materials of great delicacy and strength along with advances in our understanding of biomechanics of the face, have rendered complex injuries consistently amenable to accurate 3-dimensional reconstruction. Furthermore, with the availability of education in the techniques of internal rigid fixation, these advanced techniques have become routine practice in adults. However, the suitability of rigid internal fixation for children remains controversial. There are many concerns about the effect of implanted hardware in the mandible of a growing child. In addition, some evidence suggests that the elevation of functional matrix off of bone may result in alterations in development. The goal is to restore the underlying bony architecture to its pre-injury position in a stable fashion, with a minimal of aesthetic and functional impairment. However, in children the treatment of bony injuries is most easily accomplished by techniques that may adversely effect craniofacial development. While it is not entirely possible to resolve this dilemma, there exists an extensive body of experimental and clinical information on the appropriate management of pediatric mandibular fractures which can be used to formulate a rational treatment plan for most cases. This paper presents an overview of the contemporary understanding and application of these treatment principles.