Pediatric Mandibular Fractures Research Articles

Characteristics of pediatric mandibular condylar fractures in Southwest China: A single-center and 12-year retrospective study.

Mandibular condylar fractures in pediatric patients may exhibit distinct epidemiological characteristics attributed to their unique growth and development phase, as well as various anatomical, physiological, biomechanical, and behavioral factors that differentiate them from adults. This study aimed to investigate the demographics, injurious factors, classifications, clinical manifestations, and treatments of pediatric mandibular condylar fractures, as well as the concomitant injuries in maxillofacial and other body parts. This retrospective study analyzed the clinical data of 189 pediatric patients with mandibular condylar fractures between 2011 and 2022. Variables investigated included age, gender, timing of onset, causes, classification of condylar fracture, concomitant injuries, clinical manifestations, and treatment modalities. A total of 189 patients, a higher proportion of boys compared to girls was observed, with the highest incidence rate in children aged 1-3 years. They occurred primarily in July, June, and September as well as on Saturdays and Sundays. The most prevalent cause of mandibular condylar fractures was falls from heights in 73 patients (38.62%). Pediatric patients exhibited a higher susceptibility to condylar head fractures. A significant majority (81.48%) of these fractures were accompanied by soft tissue injuries in the maxillofacial region, with the chin being particularly vulnerable to injury. In addition, 61.90% of pediatric patients experienced fractures in other areas of the maxillofacial region, with the mandibular symphysis being the most commonly affected site. Dental trauma predominantly occurred in the anterior region (44.97%). Notably, a substantial proportion (28.04%) of cases also presented with multiple systemic injuries. The characteristics of pediatric mandibular condylar fractures exhibit distinct features in terms of age, gender, timing of onset, etiology, location and type, the presence of concomitant maxillofacial soft/hard tissue injuries and multiple systemic injuries, as well as clinical manifestations and treatment modalities. Therefore, clinicians should pay special attention to the diagnosis and treatment of pediatric condylar fractures.

The use of orthodontics in the management of a bilateral condylar fracture in a child

Mandibular fractures in children are different to those in adults. Greenstick fractures are more commonplace, and displacement less frequently encountered. They are mostly treated conservatively; however, if the occlusion is altered, then reduction will be required. Closed reduction is normally favoured in children because open surgical reduction and internal fixation may impair future growth. Closed reduction is often carried out with arch bars or splints. These may be traumatic and painful for the child. This case report describes the case of a 12-year-old boy who presented with bilateral condylar fractures with displacement and deranged occlusion. Minimal fixed appliance treatment was used to reduce the fractures and restore him to his pre-injury occlusion. CPD/Clinical Relevance: Minimal orthodontic treatment can be used to reduce a bilateral condylar fracture with displacement in paediatric mandibular fractures.

A CONSERVATIVE APPROACH TO PAEDIATRIC MANDIBULAR FRACTURE MANAGEMENT

Mandibular fractures can be considered as less frequently in children than in adult population, but when considered in children, it’s one of the commonest fractures. This less occurrence is mainly due to protective anatomical features. Treatment for pediatric mandibular fractures remains controversial and differs from that of adults. Management is extremely complicated due to developing mixed dentition. The treatment modalities lay in a wide range from conservative management to surgical options. A case of eight-year-old girl with fractures in mandibular ramus and parasymphyseal region that was managed conservatively and kept under observation is presented. This report provides a review of literature regarding the management of mandibular fractures in pediatric patients.

Frequency of mandibular fractures in children presenting with maxillofacial trauma.

Objective: To determine the frequency of mandibular fractures in children presenting with maxillofacial trauma. Study Design: Cross Sectional. Setting: Department of Oral and Maxillofacial, Ayub Dental Section at Ayub Teaching Hospital, Abbottabad. Period: 05 December 2018 to 05 June 2019. Material & Methods: A total number of 166 children from both genders between the ages of 1-12 years with a history of trauma to mandible were added to the study through consecutive non-probability sampling. All the particulars of these patients like age, gender, date of trauma, cause of trauma, pattern of trauma, associated injuries were noted down on a format designed for the study and X-rays of all the patients were taken. Results: The Mean±SDs of age in this study was 5.34+1.867. Out of these patients 96 (57.8%) were male while 70 (42.2%) were females. The results show that 66 (39.8%) patients had symphysis, 48 (29%) patients had parasymphysis, 32 (19.2%) patients had angle/body, 20 (12%) patients had condyle fractures. Associated injuries were also present in 103 (62%) patients. Conclusion: The most common type of mandibular fracture in children was symphysis followed by parasymphysis, angle/body and condyle fractures. Early identification and treatment of such pediatric mandibular fractures will help to minimize hospital stay thus reducing financial burden on patients.

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.

Conservative management of mandibular fractures in pediatric patients during the growing phase with splint fiber and ligature arch wire

PurposeThe purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire.MethodsA retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi’an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient’s medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients.ResultsOut of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed.ConclusionThe treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.

Fracture patterns, associated injuries, management, and treatment outcomes of 530 pediatric mandibular fractures.

Mandibular fractures account for up to 48.8% of pediatric facial fractures; however, there are a wide range of available treatment modalities, and few studies describe trends in adverse outcomes of these injuries. This study describes fracture etiology, pattern, management, and treatment outcomes in pediatric mandibular fracture patients. A retrospective review was performed of patients under 18 years of age who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, etiology, medical history, associated facial fractures, other associated injuries, treatments, and outcomes. A total of 530 pediatric patients with 829 mandibular fractures were included in the analysis. Most isolated mandibular fractures were treated with physical therapy (PT) and rest (n=253, 47.7%). Patients with combination fractures, specifically those involving the parasymphysis and angle, were 2.63 times more likely to undergo surgical management compared to patients with a single facial fracture (p<0.0001). Older age (p<0.001), gender (p=0.042), mechanism (p=0.008) and cause of injury (p=0.002), as well as specific fractures (e.g., isolated angle (p=0.001)) were more associated with adverse outcomes. The odds of adverse outcomes were higher for patients treated with CREF or ORIF compared to conservative management (OR=1.8; 95% Cl 1.0-3.2 and OR=2.1; 95% Cl 1.2-3.5, respectively). Fracture type, mechanism of injury, and treatment modality in pediatric mandibular fractures are associated with distinct rates and types of adverse outcomes. Large scale studies characterizing these injuries are critical for guiding physicians in the management of these patients.

Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients.

To assess the diagnostic and therapeutic approaches in pediatric mandibular fractures with regards to fracture pattern and localization. This retrospective study included patients under the age of 17 years that presented to the Department of Oral and Maxillofacial Surgery at Charité-Universitätsmedizin Berlin with mandibular fractures over an 11-year long period (2010-2020). Medical records were analyzed for age, gender, injury mechanism, clinical presentation, imaging modalities, fracture pattern, and fracture management. Statistical analyses included descriptive statistics, normality testing, and Mann-Whitney U tests. A total of 91 pediatric patients (23 females and 68 males) presented with mandibular fractures. The majority of mandibular fractures occurred in patients aged 13-16 years (67.0%, n = 61). The main causes were activities of daily life (34.1%), followed by assault (25.3%). Malocclusion and pain upon mandibular joint compression were documented in 72.5% and 51.7% of patients, respectively. The most frequently applied radiological diagnostic tool was a panoramic X-ray (49.5%). The main fracture patterns were single (42.9%) and double fractures (48.4%). An age-adapted surgical approach using open reduction and internal fixation (ORIF) was the most frequent management (61.5%). A conservative approach was favored in cases of condylar head fractures. Resorbable plates were used in eight cases of ORIF (8.8%). Treatment regimens should be carefully selected based on the unique anatomy of the pediatric patient with regards to centers of growth and dentition phase, to restore stomatognathic function and to maintain adequate skeletal growth and eruption of teeth. This study illustrates the challenges of mandibular fracture management in the pediatric patient. Hofmann E, Koerdt S, Heiland M, et al. Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients. Int J Clin Pediatr Dent 2023;16(3):499-509.

Nonsurgical Management of Pediatric Mandibular Fracture with a Customized Acrylic Open Cap Splint Luted with Glass Ionomer Cement: Two Case Reports

Nonsurgical Management of Pediatric Mandibular Fracture with a Customized Acrylic Open Cap Splint Luted with Glass Ionomer Cement: Two Case Reports

D156. Characteristics of Mandibular Fractures in the Pediatric Population

PURPOSE: Mandibular fractures account for up to 48.8% of pediatric facial fractures; however, there are a wide range of available treatment modalities, and few studies describe trends in adverse outcomes of these injuries. This study describes fracture etiology, pattern, management, and treatment outcomes in pediatric mandibular fracture patients. METHODS: A retrospective review was performed of patients under 18 years of age who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, etiology, medical history, associated facial fractures, other associated injuries, treatments, and outcomes. RESULTS: A total of 530 pediatric patients with 829 mandibular fractures were included in the analysis. Most isolated mandibular fractures were treated with physical therapy (PT) and rest (n=253, 47.7%). Patients with combination fractures, specifically those involving the parasymphysis and angle, were 2.63 times more likely to undergo surgical management compared to patients with a single facial fracture (p<0.0001). Older age (p<0.001), gender (p=0.042), mechanism (p=0.008) and cause of injury (p=0.002), as well as specific fractures (e.g., isolated angle (p=0.001)) were more associated with adverse outcomes. The odds of adverse outcomes were higher for patients treated with CREF or ORIF compared to conservative management (OR=1.8; 95% Cl 1.0-3.2 and OR=2.1; 95% Cl 1.2-3.5, respectively). CONCLUSION: Fracture type, mechanism of injury, and treatment modality in pediatric mandibular fractures are associated with distinct rates and types of adverse outcomes. Large scale studies characterizing these injuries are critical for guiding physicians in the management of these patients.

D54. Characteristics Driving “Inappropriate” Transfers of Pediatric Mandibular Fracture Patients

D54. Characteristics Driving “Inappropriate” Transfers of Pediatric Mandibular Fracture Patients

Acrylic "lollipop" for jaw rehabilitation after release of joint ankylosis in paediatric patients.

Falls are a leading cause of injuries to the temporomandibular joint (TMJ) in the paediatric age group. In low- and middle-income nations, after injury to a child's chin, a careful clinical examination of the mandible and TMJ is sometimes omitted. Paediatric mandibular condylar fractures tend to shatter the relatively narrow condylar head, leading to ankylosis to the skull base, which leads to debilitating progressive deformity.1 Early surgical release is then the sole modality of treatment and needs to be followed up by several weeks of active mouth-opening exercises to prevent re-ankylosis, which are crucial in the immediate post-operative period. Unfortunately, as patient cooperation is low owing to uncomfortable jaw mobilization, we fabricated a simple acrylic appliance which is easy to use.

Epidemiological study of the pediatric mandibular condylar fractures (the outcomes of the management); Retrospective Study

Epidemiological study of the pediatric mandibular condylar fractures (the outcomes of the management); Retrospective Study

Pediatric mandibular fractures: Surgical management and outcomes in the deciduous, mixed and permanent dentitions.

Mandibular fractures are the most frequent type of pediatric facial traumatic injury, but their treatment remains controversial. The aim of this retrospective study was to analyze the surgical treatment and long-term outcomes of dentate mandibular fractures in children and adolescents. Patients with mandibular fractures in the dentate area who were surgically treated in the period from January 1, 2001, to December 31, 2020, were included. The following data were collected: age, gender, cause and mechanism of injury, fracture site and type, associated maxillofacial fractures, the timing of surgical treatment, Facial Injury Severity Scale (FISS) score, surgical approach, number and thickness of plates, hospitalization stay and outcome. Patients were divided into three groups: deciduous (≤6 years, group A), mixed (7-12 years, group B), and permanent (13-18 years, group C) dentitions. Statistical analyses were performed using SPSS software. During the study 91 patients (male: female ratio, 3.8:1), 4 in group A, 12 in group B, and 75 in group C, with 65 single and 52 double fractures were included. An intraoral approach was used in 87% of patients. In group C, 90% of patients were treated with fixation schemes consistent with those suggested in the literature for adults, versus 75% in groups A and B. Median follow-up time was 20 months. No tooth germ injury or facial asymmetry was observed and only six group C patients had post-operative malocclusions. Hardware removal occurred in 22% of the patients. This 20-year retrospective study shows that open reduction and internal fixation of pediatric dentate mandibular fractures caused no tooth germ damage or disturbances of mandibular growth in any dentition stage. Internal fixation schemes were similar to those used for adults, although it was necessary to adapt hardware size and position according to tooth and patient age.

Paediatric Mandibular FractureAn Enigma of its Own: A Case Report

Mandibular fractures are very rare in the paediatric age group; however, they remain the most common maxillofacial trauma occurring in children. A paediatric mandibular fracture can cause severe pain and discomfort for the patient. Due to the complex anatomy of the developing mandible, such as the presence of permanent tooth buds and its small size, the treatment of mandibular fractures in the paediatric age group differs markedly from that in adults. Treatment of maxillofacial fractures in the paediatric population has always been a challenge for the operating surgeon. Different treatment modalities for managing paediatric mandibular fractures include closed reduction or surgical intervention. Open/closed cap splint provides closed reduction and stabilisation of paediatric mandibular fractures without any risk of damage to permanent tooth buds. It is more commonly preferred over Open Reduction and Internal Fixation (ORIF) of the fractures. However, for highly displaced fractures, ORIF is the preferred treatment. In the present case report, the author present and describe the management of a mandibular symphyseal and medial pole of the right condyle fracture in a seven-year-old patient. Since the bone fragments were highly displaced and occlusion was severely deranged with an anterior open bite, conservative treatment using a cap splint was not considered. ORIF was performed under general anaesthesia. At the oneyear follow-up, complete clinical and radiological bone healing was observed. Occlusion was satisfactory, and mouth opening was maintained. There was normal eruption of permanent teeth with no complications or delays associated with the eruption pattern.

A Retrospective Observational Study of Paediatric Mandibular Fractures: Demographics, Pattern and Challenges of Management in a Nigerian Population

Abstract Background: Paediatric mandibular fractures unlike adult mandibular fractures are said to be rare. When not recognised early, they may be associated with significant problems such abnormal mandibular growth. Materials and Methods: This was a retrospective observational study of paediatric patients with mandibular fractures presenting to a university teaching hospital from August 1999 to December 2019. Information sourced from patient’s case notes and operating records included age, sex, aetiology, investigation, concomitant injuries, treatment and complications. The retrieved data were recorded in a personal computer, analysed with appropriate statistical tool and presented in tables and figures. Results: A total of 550 patients who presented with mandibular fractures within the period of the study constituted the study population. Of these, 84 (15.3%) occurred in the paediatric age group. The ages of the patients ranged from 1 to 17 years with a mean age of 10.3 ± 5.0 years and there was a gender ratio (male: female) of 1.9:1. Road traffic accident accounted for most mandibular fractures. The imaging modality used in assessing mandibular fractures was mainly plain radiography and treatment was administered in 60 (71.4%) patients, with closed reduction method (n = 45; 75.0%) being the most frequent technique used. The period of hospital stay ranged from 3 to 90 days with a mean of 16.8 days. Conclusion: Mandibular fractures in paediatric population were noted to be more common in males and the main aetiology was pedestrian-related road traffic accidents. There is a need for continual review of injury prevention strategies in the paediatric group.

Use of Suture as an Alternative to Stainless Steel Wire for Stabilisation of Open Cap Splint in Paediatric Mandibular Fractures

Abstract The presence of ongoing mandibular growth and tooth buds make it challenging for the treatment of mandibular fracture in paediatric. Most common and widely used method is the use of occlusion splint which are secured with the help of circumandibular wiring. The aim of this technical note was to describe a new method for the treatment of paediatric mandibular fracture in which the occlusion splint was used and stabilized with the help of suture so as to prevent minimal trauma to the soft tissue. Management of paediatric mandibular fracture is challenging and is different then that of adult. Usually this fracture in children are manage with conventional close reduction technique because of the presence of tooth buds and developing stage of mandible. Open reduction and internal fixation is rarely used so as to prevent harm to the developing teeth it is used only if the fracture is severely displaced.

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.

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.