Mandibular Fractures In Children Research Articles

EVALUATION OF RESORBABLE MESH AND PLATE WITH ULTRASONIC WELDED PINS IN THE MANAGEMENT OF MANDIBULAR FRACTURES IN CHILDREN (A COMPARATIVE CLINICAL STUDY)

INTRODUCTION: SonicWeld Rx® system (KLS Martin) uses an ultrasonic sonotrode unit to bond a Resorb-X® pin to the Resorb-X® mesh and plates and underlying bone preclude the need to tap and decrease the time needed for fixation. Moreover, there is no second surgery needed for its removal. OBJECTIVES: This study compared the use of resorbable mesh and plates with ultrasonic welded pins in management of mandibular fractures in children. MATERIALS AND METHODS: This prospective comparative study was conducted on 20 children aged 6-12 years with mandibular fracture divided into 2 groups, group I was fixed with resorbable meshes and group II was fixed with resorbable plates. All patients were followed up clinically at the 2 nd , 7 th , 10th and 14th day postoperatively. Radiographically, all patients were examined by ultrasound(US) at 3, 6, 9 months postoperatively and by cone beam computed tomography(CBCT) at 6 months. RESULTS: Comparing the two groups clinically, there was no statistically significant difference at all stages of follow up. Radiographically, the difference in the mean thickness between the two groups was statistically insignificant at 3, 6, 9 months postoperatively. CBCT evaluation of bone density showed comparable results in both groups. CONCLUSIONS: The SonicWeld Rx® system either the mesh or the plate were found to be satisfactory in the treatment of pediatric mandibular fractures, however proper case selection is essential criteria to make them successful. Ultrasonographic aid has proved an essential diagnostic aid in assessing the biodegradation process of the resorbable material over a period of 9 months in the present study

Minimal invasive treatment using patient-specific template for mandibular fractures in children: “Wing-splint” by CAD/CAM technology

w b m s R t to seat the splint accurately, which should be at least 3 mm thick, so that it is rigid enough to fix the mandible (Fig. 2). ircummandibular fixation with wire and acrylic splints is ommonly used for the treatment of mandibular fractures n children, but has some shortcomings, including addiional laboratory processing, which can increase the duration f the general anaesthesia or require additional sedation.1,2 iodegradable fixation can be also used but also mean proonged operating time and technical difficulties, and the oreign body used can cause a reaction.3 We present a simple, inimally-invasive technique based on the concept of exteral fixation that uses a template that is specific to the patient.4 We take a high-resolution computed tomogram (CT) of he craniofacial skeleton according to a standard protocol. atasets from this or any initial diagnostic scans that we lready have are imported into software (Mimics, Materilise, Leuven, Belgium) and converted to a 3-dimensional irtual model. The teeth are then separated from the virtual andible so that we can see the roots of mixed dentition and ermanent tooth buds. Before the virtual reduction, we create our cylinders (2.0 mm in diameter) on the mandible (Fig. 1). his is to allow us to position fixation screws precisely and

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.

Application of biodegradable plates for treating pediatric mandibular fractures

ObjectiveWe assessed the clinical results of a biodegradable plate system for the internal fixation of mandibular fractures in children, and observed the imaging features of fracture healing and bone changes around the biodegradable plates and screws during follow-up. Patients and methodsWe enrolled 39 patients (22 male, 17 female, average age 4 years 10 months) with different mandibular fractures. We used 2.0-mm resorbable plates to repair the fractures. Postoperative follow-up ranged from 6 months to 5 years; average follow-up was 1 year 2 months. The outcome measures identified and assessed included facial symmetry, mouth opening, occlusal relationship, infection, nonunion, malunion, and plate dehiscence. ResultsWe fixed 42 fractures with 43 resorbable plates; the fracture site of one patient (aged 11 years 3 months) was fixed with two plates. Two patients developed small fistulas at the intraoral incision 2 months after surgery; the fistulas healed after 1 month without special treatment. In the other patients, the incision healed well, there was facial symmetry, mouth opening was >35 mm, and occlusion was good. Follow-up computed tomography examination data were available for 20 cases, and revealed different degrees of radiolucency indicating that osteolysis had occurred. Radiolucency was observed around the resorbable plates 1 month after the surgery. The extent and depth of the radiolucent region were obvious within 1 year of surgery. In the second year, there were obvious repairs, with the bony defect areas becoming shallower. After 2 years, the bony defect areas had almost disappeared. ConclusionBiodegradable fixation devices are safe and efficient for treating pediatric mandibular fractures. Osteolysis commonly follows biodegradable fixation of pediatric mandibular fractures, and has no adverse effect on fracture healing.

Management of Symphysis and Parasymphysis Mandibular Fractures in Children Treated with MacLennan Splint: Stability and Early Results.

ABSTRACTObjective: The aim of this study was to assess the safety and efficiency of MacLennan splint in symphysis and parasymphysis mandibular fractures in children.Study design: Six patients (four boys and two girls, mean age 3 years, range between 2 and 5 years) were operated on parasymphysis fractures of children. The mean follow-up time was 12 months. MacLennan splint was applied in these case upto 3 weeks.Results: Primary healing of the fractured mandible was observed in all patients. Postoperative complications were minor and transient. The outcome of the operation was not endangered. Adverse tissue reaction like infection, malocclusion, swelling and growth restrictions did not occur during observation period.Conclusion: MacLennan splint is having various advantages like faster mobilization and the avoidance of secondary removal operations. Based on this preliminary results MacLennan splints are safe and efficient in the treatment of pediatric mandible fracture.How to cite this article: Khairwa A, Bhat M, Sharma A, Sharma R. Management of Symphysis and Parasymphysis Mandibular Fractures in Children Treated with MacLennan Splint: Stability and Early Results. Int J Clin Pediatr Dent 2015;8(2):127-132.

Two Cases of Mandibular Fractures in Child Treated by Open Reduction and Internal Fixation with a Titanium plate

In the treatment of mandibular fracture in child, avoiding any damage to uneruptal tooth bud, and growth and development of mandible bone are considered exceptionally.Therefore, reduction and fixation by splint and circumferential wiring is performed generally. However, in the case of displaced fracture, open reduction and internal fixation(ORIF) should be applied. On the other hand, the case of condylar fracture needs the jaw opening exercise early to prevent mandibular ankylosis. For that reason, in the case of condylar and mandibular body fracture, it is important to perform ORIF of mandibular body fracture as soon as possible. We report two cases of mandibular fracture (midline and bilateral condyle) in 3 years-old and 10 months boy and 1 years-old and 9 months girl. We planed the operation in reference to CT scans to avoid uneruptal tooth bud and ORIF of midline fracture with a titanium plate was performed. The titanium plate was removed after 6 month, for preventing growth and development of mandible bone. Postoperative causes have been uneventful. e-228 Case 1: 3 years-old and 10 months boy fell from a height of 2 meters. ORIF of midline fracture with a titanium plate was performed on December 3rd, 201X. Case2: 1 years-old and 9 months girl fell from bicycle driving by her mother. ORIF of midline fracture with a titanium plate was performed on September 29th, 201X. As they did not need intermaxillary fixation, they could open the mouth and take ordinary diet at early stage of the post operation. Conclusions: In the treatment of mandibular fracture in child, we made a plan of the plating position and the size of screw in reference to CT scans, and ORIF of mandibular fracture with a titanium plate was performed safety.

Causes and Treatment of Mandibular and Condylar Fractures in Children and Adolescents

There are no uniform treatments, standards, and specifications for conservative and surgical management of mandibular fractures in children and adolescents. To review the management of mandibular fractures in children and adolescents at our institution. The medical records of 104 children and adolescents (60 male and 44 female) treated for mandibular fractures from 2005 to 2012 at the Ninth People's Hospital, Shanghai, China, were retrospectively reviewed. The participants were classified as having deciduous dentition (age ≤6 years), mixed dentition (age >6 but <12 years), and permanent dentition (age ≥12 but ≤16 years). Conservative treatment and surgical management. Helkimo clinical dysfunction and anamnestic indices. Condylar process fractures accounted for 55.7% of the fractures (112 fractures of 201 total fracture sites), and symphysis fractures, parasymphysis fractures, fractures of the body, and fractures of the angle accounted for 20.9%, 11.9%, 7.0%, and 3.5% of the fractures, respectively. A total of 83 cases with 159 fracture sites with complete follow-up data were included in the treatment analysis. In these 83 patients, 77 fractures were dentigerous bone fractures, 46 were intracapsular fractures, and 36 were extracapsular fractures. Dentigerous bone fractures of the mandible were managed by closed or open reduction in children younger than 12 years and were managed more often by open reduction and fixation in those between ages 12 and 16 years. Closed treatment was performed for 22 condylar process fractures (28.6%), and open reduction was carried out for 55 condylar process fractures (71.4%). In patients with intracapsular fractures, there was no significant relationship between dentation age and treatment method (P = .06). Most patients with extracapsular fractures with permanent dentition underwent surgical fixation (73.3%), whereas most with deciduous dentition received conservative treatment (87.5%). In patients with condylar process fractures, there was no significant difference in Ai and Di based on treatment method (P = .49 and P = .76, respectively). The treatment of mandibular fractures in children and adolescents should be determined by clinical factors including age, location, and type of fracture.

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.

The use of resorbable plates in association with dental arch stabilization in the treatment of mandibular fractures in children

PurposeThe purpose of this study was to investigate the effect of resorbable plate fixation in association with dental arch stabilization in the treatment of displaced mandibular fractures in children. Patients and methodsThirteen children (5 girls and 8 boys, age range 2 years 5 months to 12 years 2 months) with displaced mandibular fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using resorbable plates and monocortical screws placed at the lower border of the mandible. At the same time, an arch bar or orthodontic wire splint was anchored using stainless steel wires or resin on the teeth to stabilize the whole mandibular dental arch. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mandible movement, and mandible growth. ResultsPostoperatively, all patients achieved uneventful healing; premorbid occlusion restoration and wound healing were achieved, along with unimpaired function and normal growth and development of the mandible. Complications such as damage to tooth buds, infection, malunion, and nonunion were not encountered in these patients. ConclusionResorbable plates use in association with dental arch stabilization can provide good stabilization for mandibular fractures and is a promising approach for the treatment of displaced mandibular fractures in children.

Mandibular fractures in children under 3 years: A rare case report

Mandibular fractures in children are relatively rare, not only by their anatomical and physiological aspects, but also by their social factor, which makes this group less exposed to high-impact trauma. Thus, the specific pediatric treatment, through a minimally invasive approach should also be established, avoiding future functional disorders. In our case, a female patient, a 3-year-old accident victim was affected by a domestic symphysis fracture and bilateral mandibular condyle. Surgical treatment of fractures of the mandibular symphysis was performed two days after the trauma, under general anesthesia for reduction and fixation, employing a 1.5 titanium plate system in the midline of the mandibular symphysis. The condylar fractures were treated conservatively, immediately using gruel and oral therapy to avoid complications such as temporomandibular joint ankylosis. The patient has been followed up by our staff and has no restriction in mandibular movements and no limitation of mouth opening.

Resorbable plates for fixation of complicated mandibular fractures in children.

The purpose of this article was to review our experience in the treatment of complicated mandibular fractures in children using resorbable plates. Records of 14 patients who sustained and presented to our department with complicated fractures of the mandible, and were treated with resorbable plates were retrieved. Permission was sought from and granted by the institution ethical committee. Data extracted included patients' gender, age, etiology of fracture, nature of fracture and site of the fracture. Of the 14 patients, there were 10 males and 4 females with a male to female (M:F) ratio of 2.5:1. Their ages ranged from 6 to 15years, with a mean of 10.14 years. The etiology of the fractures included road traffic accidents (n=11) and falls (n=3). Most of the fractures were sustained on the body of the mandible. Majority of the patients had displacement of the fracture segments; 2 patients had comminuted fractures. All the fractures were treated using resorbable plates and healed uneventfully. Whereas the number of patients in this case series was small, it is worth noting that children sometimes present with complicated fractures of the mandible, thereby necessitating open reduction and internal fixation. Resorbable plates when available and affordable, are an effective option for open reduction and internal fixation of such fractures.

Acrylated stainless steel basket splint for mandibular fractures in children

Acrylated stainless steel basket splint for mandibular fractures in children

Management of mandibular fractures in children with a split acrylic splint: a case series

Five children with mandibular fractures were treated with a split acrylic splint, which secured the fracture by wiring around the mandible. The occlusion was satisfactory, without infection or malocclusion. None required revision, and there was no deviation of the mandible, ankylosis, or disturbances of growth.

Mandibular fractures in children: Analysis of 61 cases and review of the literature

Objective The purpose was to evaluate the incidence, etiology, site and patterns, management and treatment methods, and outcome of pediatric patients with mandibular fractures. Methods Pediatric patients (1.5–16 years old) with mandibular fractures, treated at the Soroka University Medical Center were included in the study. Age, gender, etiology, site and type of fracture, associated injuries, mode of treatment, outcome, complications, and follow up were evaluated. The cases were divided into 3 age groups: Group A: 1.5–5 years, Group B: 6–11 years, and Group C: 12–16 years. Results Sixty one patients were included in the study. The male to female ratio was 2:1. Motor vehicle accident was the most common cause. Associated trauma was more common in young children. The condyle was involved in 54% of the fractures. Closed reduction and intermaxillary fixation was the most common treatment used. Complications were rare. Conclusion Management of mandibular fracture in the pediatric age group is a challenge. The anatomical complexity of the developing mandible and teeth strongly suggest the use of surgical techniques that are different from those routinely used in adults. The conservative approach is recommended. Whenever possible closed reduction should be the treatment of choice.

A retrospective Study of Mandibular Fracture in Children

Background and objective: A retrospective study was done to report the incidence of mandibular fractures in children up to fifteen years of age seen in Rizgaree teaching hospital /Erbil / Kurdistan region of Iraq. Methods: The patient's records of 62 injured child aged 0-15 years, from 1/1/ 2002 to 31/12/2008 were retrieved and relevant data was recorded and analysed. A data collection sheet was designed to record patient's name, sex, age, site of fracture, the etiology of the injury and the method of treatment and complications. Results: The total number of patients who presented with mandibular fracture in children was 62 (78.5%). The ratio of boys to girls was 43 (69.4%) boys and 19 (30.6%) girls (2.2:1). Most of the trauma reported in age group 12-15years (46.8%). Regarding the site of fracture, condylar fracture (46.7%) was most common followed by symphesis (27.4%), dentoalveolar (14.5%), angle (8.1%) and body (3.3%). The main etiology of fracture was fall from height (54.8%). Most of the patients were treated by closed reduction (88.7%) and fixation. Conclusion: The incidence and etiology of mandibular fracture in children differs among different populations. In our study, the incidence was not very common, fall was most common cause, condylar fracture was most common. Most of the cases can be treated conventionally.

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

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

O.404 Envelope approach for onlay bone grafting

Mandibular fractures in children treated in our department between March 1994 and January 2001 were retrospectively studied. Age, sex, type of fracture, etiology and evolution after treatment, functional mobility and maximal mouth opening were recorded. The population consisted of 19 patients who sustained 30 fractures. The patients ages ranged from 1.5 to 18 years. The mean time of follow up was 28 months. The male to female ratio was 1.7:1. Traffic and bicycle accidents were the main causes of the fractures. The condyle was involved in 16% of the cases, the subcondylar region in 28%. Fractures were multiple in half of the cases. Isolated fractures of the condyloid joint were treated conservatively. For isolated subcondylar fractures, maxillomandibular fixation was the treatment in 40% of the cases. Otherwise, conservative functional treatment was used. Children with a combination of body and condyle fractures were treated by open reduction and maxillomandibular fixation. Neither infection nor retarded facial growth was observed. Only one case of ankylosis of the temporomandibular joint (TMJ) and one case of temporomandibular pain syndrome were recorded. Associated lesions might concern the extremities, the brain and the cervical spine.

Indications and Limitations in Resorbable P(L70/30DL)LA Osteosyntheses of Displaced Mandibular Fractures in 4.5-Year Follow-Up

This study evaluates prospective 4.5-year follow-up of available poly(l-lactide-co-dl-lactide) [P(L70/30DL)LA] resorbable plate osteosyntheses in displaced traumatic and pathological mandibular fractures. P(L70/30DL)LA miniplates and screws were used to fixate 50 displaced fractures in 30 patients, aged 1 to 83 years, with their informed consent. There were 15 traumatic paramedian, seven corpus, 11 angle, and 10 condyle fractures, and seven pathological fractures due to atrophy, osteomyelitis, or third molar osteotomy. Double osteosyntheses were preferred, with one monocortical plate at the dentoalveolar basis (6-mm screws) and a second plate at the inferior margin (8-mm screws). The average follow-up was 31 months (range, 6 to 53 months). Fifteen (100 percent) traumatic paramedian, seven (100 percent) corpus, 10 (91 percent) angle, 10 (100 percent) condylar, and three (43 percent) pathological fractures healed primarily. Two mandibular angle fractures, traumatic and pathological, each initially healed, but 6 weeks postoperatively the first fracture re-dislocated on removal of a dental impression by the family dentist, and the second re-dislocated after mastication of hard food. One atrophic corpus fracture developed a rigid fibrous union in an 83-year-old patient; a preexistent osteomyelitis and fracture progressed to further bone loss and finally required preformed fibula reconstruction. Use of the tested resorbable plates can be encouraged in multiple displaced mandibular fractures in children and likewise in highly compliant dentate adolescents and adults with doubled osteosyntheses; traumatic mandibular angle and pathological fractures, however, remain critical for nonunion. These necessitate evaluation with future smaller, more rigid, and, it is hoped, more economical fixations.

The Pediatric Mandible: II. Management of Traumatic Injury or Fracture

After studying this article, the participant should be able to: 1. Describe the changing epidemiology of mandibular fractures in children and adolescents. 2. Discuss the appropriate use of internal fixation in the treatment of pediatric mandibular fractures. 3. Describe the difficulties posed by the deciduous dentition in the use of interdental wiring. 4. Understand reasons why techniques specific to adult fractures may not be applicable to the growing mandible. 5. Understand the etiology and epidemiology of pediatric mandibular fractures. 6. Understand the reasons for conservative (closed) versus aggressive (open) treatment of mandibular injury. Fractures of the pediatric mandible are complicated by the anatomic complexity of the developing mandible, particularly by the presence of tooth buds and the eruption of deciduous and permanent teeth. Traditional methods of fracture reduction and fixation employed in adults have little applicability in the pediatric population. The authors describe the surgical techniques that have been used at their institution and those that can be used safely in the pediatric setting. In most cases, "conservative" management is the preferred option, especially in the treatment of condylar fractures. In cases requiring surgical intervention, interdental wiring, drop wires in combination with circummandibular wires, and acrylic splints are suited well to specific phases of dental maturation. Open reduction and internal fixation using monocortical screws and microplates or resorbable plates and screws are acceptable techniques in the pediatric patient, but they require special safeguards. Algorithms are presented to simplify management of these complicated injuries.

Biodegradable fixation of mandibular fractures in children: Stability and early results

The aim of this study was to assess the safety and efficiency of biodegradable self-reinforced (SR-PLDLA) bone plates and screws in open reduction and internal fixation of mandible fractures in children. Thirteen patients (5 female, 8 male; mean age 12 years, range 5-16 years) were operated on various fractures of the mandible (2 symphyseal, 6 parasymphyseal, 4 body, 3 angle, 1 ramus, 2 condylar fractures). The mean follow-up time was 26.4 months (range 10.9-43.4 months). Intermaxillary fixation was applied in cases with concomitant condylar fractures up to 3 weeks. Primary healing of the fractured mandible was observed in all patients. Postoperative complications were minor and transient. The outcome of the operations was not endangered. Adverse tissue reactions to the implants, malocclusion, and growth restrictions did not occur during the observation period. Pediatric patients benefit from the advantages of resorbable materials, especially from faster mobilization and the avoidance of secondary removal operations. Based on these preliminary results, self-reinforced fixation devices are safe and efficient in the treatment of pediatric mandible fractures. However, further clinical investigations are necessary to evaluate the long-term reliability.