Pediatric Mandible Research Articles

Chronic Osteomyelitis Following Foreign Body Entrapment in Pediatric Mandible-a Case Reprt.

Chronic osteomyelitis resulting from foreign body entrapment in the pediatric mandible presents unique challenges in diagnosis and management. Habitual insertion of objects into the oral cavity by children can lead to serious complications such as discharging sinuses and osteomyelitis. We present a case of a 12-year-old boy with extra-oral pus discharge originating from the mandible, ultimately traced to an embedded iron nail adjacent to a carious first molar. Radiographic imaging played a crucial role in diagnosis, revealing the foreign object and. Long-term follow-up showed successful healing with prompt treatment. Prevention through parent education, meticulous examination, and interdisciplinary collaboration are emphasized to avoid such complications.

Analysis of the effects of mandibular reconstruction based on microvascular free flaps after oncological resections in 21 patients, using 3D planning, surgical templates and individual implants

IntroductionPost- resection defects in the area of the head and neck frequently result in functional impairment of the masticatory system and unaesthetic outcome in the facial appearance. In pediatric population they exert a devastating effect on speech development, breathing and facial growth leading to secondary deformations which are extremely challenging in reconstruction by means of conventional surgery protocols. Material and Methods21 patients (14 males/ 7 females) aged 4–17 years old, treated between 2015 and 2019 due to malignant/benign tumors or congenital deformities requiring mandible resection were enrolled in the study. All patients underwent Virtual Surgical Planning (VSP), mandible tumor resection with use surgery guides and defect reconstruction with microvascular bone graft supported with custom implants. Postoperatively, 3D models used for the planning and postoperative 3D model of the reconstructed mandible were compared using authors method based on easily measurable morphometric measurements (3 angles, 3 linear dimensions), allowing a three-dimensional quantitative assessment of postoperative outcomes of the surgery. Linear regression analysis and one-way analysis of variance were used to evaluate the clinical material. The difference was considered significant if p < 0.05. ResultsFree fibula flap (FFF) was most commonly used type of the reconstruction of the pediatric mandible. The average maximum deviation for the analyzed cases was 7.7 mm, and the average minimum deviation was −6.09 mm, however without significant differences and the postoperative position of the mandible condyle was comparable to the position designed in the 3DVSP preoperatively. Position of the whole reconstructed mandible by means of individually planned grafts and plates provided comparable position of the ramus and mandible body and no chin deviation as the differences between the pre-operative axial and sagittal angles and their post-operative equivalents were insignificant (p > 0,05). ConclusionsThis study confirms applicability of the 3DVSP in pediatric craniomaxillofacial surgery. Preoperative planning of the osteotomies, grafting technique and production of the individualized guides and implants provides precise tumor resection and immediate reconstruction adjusted to the specific anatomy of the pediatric patients.

Primary intraosseous carcinoma in the pediatric and adolescent mandible

BackgroundPrimary intraosseous carcinoma (PIOC) is a rare malignant odontogenic tumor that predominantly occurs in males older than 50 years. PIOC can be misdiagnosed as odontogenic cyst because it occasionally shows a well-defined border on radiography. In this study, related literatures of pediatric and adolescent PIOC cases were analyzed under strict PRISMA guidelines along with an adolescent case who was provisionally misdiagnosed as an odontogenic cyst.MethodsAll case reports for PIOC published in English from 1966 to 2021 were collected. Cases under the age of 20 were classified as pediatric and adolescent populations in this study. A total of 12 pediatric and adolescent cases including 11 PIOCs from the literature and one new case of a 14-year-old female were analyzed. Clinical and radiographic features, diagnosis and treatment approaches, and prognosis were investigated.ResultsAges ranged from 4 to 18 years. The female to male ratio was 1.4:1. Seven cases occurred in the mandible. Swelling was observed in 11 patients. The radiologic borders were well-defined in six cases and corticated in four cases. Tooth displacement and root resorption were observed in four and six cases, respectively. The provisional diagnosis for seven patients was odontogenic cyst and enucleation was performed in six cases including the new case. During the follow-up period, local recurrence occurred in three patients. The pediatric and adolescent PIOC cases with local recurrence showed poor prognosis. The locally recurred lesion in the new case did not decrease in size despite concurrent chemo-radiation therapy.ConclusionsThree-dimensional imaging modalities and incisional biopsy with multiple specimens are necessary to rule out PIOC in the lesions with atypical radiographic findings. PIOC should be diagnosed differentially from odontogenic cyst even in pediatric and adolescent populations to properly manage the disease with poor prognosis.

Coronoid Foramina in a Pediatric Mandible: An Incidental Finding of a Morphologic and Developmental Anatomic Variant as a Distinctive Documented Feature

The new advancing technologies have created a storm in the long-existing canons of anatomic sciences with the bandwagon of recent anatomical discoveries such as the existence and identification of a bilateral foramen in the coronoid process of the mandible. The coronoid process being a thin flat triangular process varies in shape and size and gives attachment to the main muscles of mastication the temporalis and the masseter. The excitement of exploratory anatomic victory on mysteries related to the anatomy of the head-and-neck region specific to the coronoid process was further documented and elaborated as an incidental finding. The following manuscript presents an intriguing case of a pediatric patient aged 7 years with a morphologic variation of coronoid process with presence of foramina bilaterally along with few other variants, further attempting to emphasize its occurrence in the developmental years as a possibility of developmental variant trait.

Role of Cinnarizine as an adjuvant treatment in cases of postviral hyposmia

Background Injuries in children are very common, and nine million children from birth to the age of 19 years are treated every year in the emergency departments for accidental injuries, costing $87 billion. Involuntary injury is ranked as the number one cause of illness and death in children 1 year and older. Facial fractures are relatively rare in children and account for 1–15% of all facial fractures. Aim To evaluate the efficacy of open reduction and semirigid internal fixation in the management of displaced pediatric mandibular fractures. Patients and methods This study was conducted on 25 patients who have mandibular fracture. All cases were subjected to open reduction and semirigid internal fixation mandibular fractures. This study was carried out at the Otorhinolaryngology Department at Benha University Hospital and El Galaa Military Medical Complex in the period from May 2019 to May 2020. Results Fixation was done in all of the cases by 1.5‑mm titanium miniplates and 1.5‑mm diameter 7‑ or 9‑mm length titanium screws, with plate removal after 6 months. Conclusion Open reduction and semirigid internal fixation with titanium miniplates is a reliable and a safe method in the treatment of displaced fractures of the pediatric mandible, with no danger regarding the erupted or unerupted tooth follicles. Keywords: displaced pediatric mandibular fractures, open reduction, semirigid internal fixation.

The Hypoplasic Mandible: What Makes it Different From the Healthy Child?

This study aimed to analyze the morphology of the hypoplasic mandible and its evolution during the growth period to better understand how it differs from the pediatric healthy mandible. Three-dimensional mandibular models of hypoplasic and healthy children aged from 39 gestational weeks to 7 years old were analyzed with a morphometric method including data clustering. Morphological distinctions between pathological and healthy mandibles were highlighted. Bilateral and unilateral mandibular hypoplasia were distinguished. The study sample was composed of 31 hypoplasic children and as many sex- and age-matched healthy children. Morphological distinctions between pathological and healthy mandibles were highlighted only from the first year of life. In bilateral hypoplasia, the overall mandibular dimensions were reduced while there was only a ramus asymmetry in unilateral mandibular hypoplasia (mean ± SD of the difference between the Grp03c and Grp03b subgroups: 6.80 ± 6.37 - P value = 1.64e-3 for the height of the left ramus versus 0.18 ± 4.18 - P value = .82 for the height of the right ramus). Supervised classification trees were built to identify the pathology and discriminate unilateral from bilateral mandibular hypoplasia (prediction rates = 81% and 84%, respectively). Based on a morphometric analysis, we demonstrated that mandibular hypoplasia significantly impacts the mandibular morphology only from the first year of life, with a distinction between bilateral and unilateral hypoplasia.

Management of Mandibular Angle Fracture in a 9-year-old with Miniplate and Monocortical Screws: A Clinical Challenge.

The main characteristic feature of the pediatric mandible is that of decreased dimension, which leads to compromises in the open reduction and internal fixation (ORIF). In the dental segment, the cervically bulbous short stature primary teeth might act an obstacle during the maxillomandibular fixation conventionally. An increased osteogenic potential of bones favors rapid consolidation and remodeling in the affected region. The mixed dentition of the ugly duckling stage adds more burden while stabilizing the fractured segments. The main goal of the clinician is to achieve and restore the facial appearance and function. Hereby, we present a clinical challenge depicting a 9-year-old male with mandibular angle fracture managed by miniplate and monocortical screws fixation.How to cite this article: Shunmugavelu K, Subramaniam K. Management of Mandibular Angle Fracture in a 9-year-old with Miniplate and Monocortical Screws: A Clinical Challenge. Int J Clin Pediatr Dent 2017;10(4):391-393.

The use of computer-aided design/manufacturing (CAD/CAM) technology to aid in the reconstruction of congenitally deficient pediatric mandibles: A case series

BackgroundMicrovascular reconstruction of the pediatric mandible, particularly when necessitated by severe, congenital hypoplasia, presents a formidable challenge. Complex cases, however, may be simplified by computer-aided design/computer-aided manufacturing (CAD/CAM) assisted surgical planning. This series represents the senior authors’ preliminary experiences with CAD/CAM assisted, microvascular reconstruction of the pediatric mandible. MethodsPresented are two patients with hemifacial/bifacial microsomia, both with profound mandibular hypoplasia, who underwent CAD/CAM assisted reconstruction of their mandibles with vascularized fibula flaps. Surgical techniques, CAD/CAM routines employed, complications, and long-term outcomes are reported. ResultsSuccessful mandibular reconstructions were achieved in both patients with centralization of their native mandibles and augmentation of deficient mandibular subunits. No long-term complications were observed. ConclusionsCAD/CAM technology can be utilized in pediatric mandibular reconstruction, and is particularly beneficial in cases of profound, congenital hypoplasia requiring extensive, multi-planar, bony reconstructions.

Piezoelectric Osteotomy for Distraction Osteogenesis of the Pediatric Mandible

Distraction osteogenesis of the mandible requires a complete osteotomy so that the proximal and distal segments may be separated, thereby producing length. One of the main complications of this technique is lingual nerve injury due to trauma induced by either the saw or the osteotome. The purpose of this article was to suggest the use of piezosurgery in performing near-complete osteotomy of either the body or ramus of the mandible. Surgical procedure was performed under general anesthesia, and it lasted approximately 90 minutes. After the buccal cortex of the mandible was dissected, a piezosurgical device was used for the planned osteotomy. The gap created by the device allowed visualization of the nerve, thereby permitting completion osteotomy of the lingual cortex. The patient did not show any neurological postoperative complication. The use of piezoelectric surgery appears to be a safer option in performing distraction osteogenesis of the pediatric mandible. The presumed disadvantage of this technique, notably an increased operating time due to the lower power cut of the piezoelectric device, was not encountered.

Flap Selection in Head and Neck Cancer Reconstruction

ABSTRACTAdvances in head and neck reconstruction techniques have improved the results in function and the aesthetic outcome. Several flaps with different composition are available for specific reconstruction to achieve optimum result. Sensate free tissue transfer, dental rehabilitation and epiphyseal transfer for pediatric mandible are also now possible to achieve better function. The specific choice of the flap according to the region of defect and important keypoints in harvesting and reconstruction strategy for head and neck cancer are based on our experience in the last two decades.How to cite this articleBaliarsing AS, Thorat TS, Gupta A, Bhat U, Garg S, Bhattacharyya D. Flap Selection in Head and Neck Cancer Reconstruction. Int J Otorhinolaryngol Clin 2013;5(2):63-76.

Flap Selection in Head and Neck Cancer Reconstruction

ABSTRACTAdvances in head and neck reconstruction techniques have improved the results in function and the aesthetic outcome. Several flaps with different composition are available for specific reconstruction to achieve optimum result. Sensate free tissue transfer, dental rehabilitation and epiphyseal transfer for pediatric mandible are also now possible to achieve better function. The specific choice of the flap according to the region of defect and important keypoints in harvesting and reconstruction strategy for head and neck cancer are based on our experience in the last two decades.

Management of Pediatric Mandible Fractures

The pediatric mandible fracture is a rare occurrence when compared with the number of mandible fractures that occur within the adult population. Although the clinician who manages facial fractures may never encounter a pediatric mandible fracture, it is a unique injury that warrants a comprehensive discussion. Because of the unique anatomy, dentition, and growth of the pediatric patient, the management of a pediatric mandible fracture requires true diligence with a variance in treatment ranging from soft diet to open reduction and internal fixation. In addition to the variability in treatment, any trauma to the face of a child requires additional management factors including child abuse issues and long-term sequelae involving skeletal growth, which may affect facial symmetry and occlusion. The following is a review of the incidence, relevant anatomy, clinical and radiographic examination, and treatment modalities for specific fracture types of the pediatric mandible based on the clinical experience at the University of Miami/Jackson Memorial Hospital Oral and Maxillofacial Surgery program. In addition, a review of the literature regarding the management of the pediatric mandible fracture was performed to offer a more comprehensive overview of this unique subset of facial fractures.

Trauma of facial skeleton in children: An indian perspective

Both children and adults are subject to similar types of injuries but fractures of facial bones in children are relatively uncommon. The aim of this study was to evaluate the epidemiology of facial bone fractures among children of <12 years, their management and outcome in an Indian city. This retrospective study included children of <12 years of age with facial bone fractures admitted over a span of 3 years. In order to compare our results we reviewed the existing literature related to pediatric facial bone fractures. A total of 45 children were admitted for facial bone fractures. Forty (89%) of them were above 5 years of age and male to female ratio was 2:1. About 53.33% of these injuries were because of fall from height. Mandible fracture was the most common facial bone fracture among admitted patients. Symphysis and para-symphysis was the commonest site of mandibular fractures, seen in 49% cases. Majority of these fractures were managed by Inter-maxillary fixation and inter-osseous wiring. Mini-plates were used for widely displaced compound fractures. For un-displaced fractures observation alone was sufficient. Mandible is the commonest facial bone fracture in children, more often caused by accidental fall from height. The high osteogenic potential of pediatric mandible allows non-surgical management to be successful in an increased proportion of younger patients.

Desmoid Tumors of the Pediatric Mandible

Desmoid tumors are benign fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. These rare neoplasms have been shown to account in 0.03% of all cancers. Twenty-five percent of all desmoid tumors occur in children under 15 years of age. The infrequency of these tumors has limited studies to case reports and retrospective reviews dictating the authors recommended treatments and management. We present a case report of desmoid tumor involving the left mandible in a 14-month-old infant. His treatment course included 2 excisions, removal of the free rib graft secondary to persistence of the tumor, and wound dehiscence, and later a free fibular osteomyocutaneous flap for reconstruction. We then retrospectively reviewed all published data of desmoid tumor involving the pediatric mandible since 1950 to 2007 in the PubMed database. Forty cases have been reported, which had a M:F ratio of 1:1 with an average age of 5.3 (standard deviation [SD] +/- 4.5) years. There appeared to be left-sided predominance of desmoid tumors in the pediatric mandible with a ratio of 3:1. The mean size of the tumors was 4.6 cm (SD +/- 2.1) at the largest diameter. We have tabulated the relevant data of all the cases including the methods of treatment and recurrence. It is found that when compared with conservative management, radiation therapy, chemotherapy, and curettage or surgical local excisions as treatment options the most efficient treatment was partial mandiblectomy, which resulted in complete tumor dissipation with no tumor recurrence. In summary, this is the largest review of the pediatric desmoid tumor of the mandible to date where we provide for the first time an algorithm for the management and treatment of the pediatric desmoid tumor of the mandible.

External Distraction Osteogenesis in the Pediatric Mandible

Mandibular distraction osteogenesis is an effective tool with which to correct facial asymmetry, restore proper occlusion and, more importantly, create an appropriate airway in the micrognathic infant. As a component of many syndromes, micrognathia can impair feeding and speech development and can obstruct the neonatal airway. However, bony lengthening secondary to external mandibular distraction osteogenesis can provide added space, preventing oropharyngeal soft tissues from occluding the airway. Although external distraction of the mandible has been applied for more than a decade, this procedure often proves technically challenging. Here, as a supplement to their video presentation, the authors present a practical discussion of their current technique for mandibular distraction osteogenesis using an external device in a child with Treacher Collins syndrome.

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

Microvascular Reconstruction of the Pediatric Mandible

Microvascular Reconstruction of the Pediatric Mandible

The conservative treatment of pediatric mandibular fracture with prefabricated surgical splint: a case report

The use of rigid fixation in children is controversial and may cause growth retardation along cranial suture lines. Intermaxillary fixation for mandibular fractures should be used cautiously as bony ankylosis in the temporomandibular joint (TMJ) and trismus may develop. The high osteogenic potential of the pediatric mandible allows non-surgical management to be successful in younger patients with conservative approaches. In this case, successful conservative treatment of mandibular fracture of a 3-year-old patient is presented.

Microvascular Reconstruction of the Pediatric Mandible

Free tissue transfer for adult mandibular reconstruction is a well-established technique; however, there are few reports of pediatric microvascular lower jaw reconstruction. This retrospective study was undertaken to review the range of indications, choices, safety, and efficacy of pediatric free tissue transfer to the lower jaw. All patients underwent a parascapular, scapular, or fibula free tissue transfer. Flap choice was based on preoperative clinical examination, radiographic findings, need for linear or multiplanar mandibular reconstruction, need for dental restoration, severity of soft-tissue deficit, and peroneal artery anatomy. Over a 10-year period (1989 to 1999), we performed eight free tissue transfers to reconstruct the mandibles of seven children, aged 6 to 17 years. Indications included radiation-induced hypoplasia (n = 1), postsurgical resection of fibrous dysplasia (n = 1), hemifacial microsomia (n = 3), Robin sequence with severe micrognathia (n = 1), and osteomyelitis (n = 1). The authors transferred four parascapular osseocutaneous, two scapular osseocutaneous, one fibular osseocutaneous, and one fibular osseous flap to reconstruct five ramus, four condyle, and two subtotal mandibular defects. All bony defects were successfully bridged and all osseous flaps successfully integrated. Postoperatively, mandibular symmetry and Angle class I occlusion were restored in all patients throughout the 10.5-year follow-up period (range, 9 to 14 years). Two patients received osseointegrated dental implants. Our only complication was the partial loss of a skin paddle. Microvascular reconstruction of the pediatric mandible, in selected patients, is a safe, reliable procedure that provides the bone stock and soft tissue necessary to restore normal maxillomandibular growth and dental rehabilitation.

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.