Pediatric Mandible Fractures



10.1055/b-0034-97695

Pediatric Mandible Fractures

Noopur Gangopadhyay & Albert S. Woo
(a-d) A 7-year-old boy presents to the emergency department after an ATV (all-terrain vehicle) crash with pain in his jaw and occlusal abnormalities.


Description




  • Comminuted and significantly medially displaced bilateral subcondylar fractures.



  • Comminuted right mandibular body fracture.



  • Greenstick fracture of the inner (lingual) table of the mandibular symphysis.



  • Multiple injured teeth.



Work-up



History and physical examination




  • Complete trauma evaluation, including ABCs (airway, breathing, circulation).




    • Must evaluate risk for airway compromise. Rarely, intubation may be necessary to protect the airway.



    • Evaluate for associated injuries, including cervical spine injuries.



  • Difficult to assess history in children. They may describe jaw pain with movement and noticeable changes in occlusion.



  • Inspect face for asymmetry and areas of tenderness, swelling, or ecchymosis.




    • Ecchymosis of preauricular areas can indicate underlying fractures.



    • Chin laceration may indicate superiorly directed force consistent with condylar fractures.



    • Deviation of jaw opening or limited mobility.



    • Intraoral examination may reveal lacerations or hematomas; evaluate for dental injuries, including presence of permanent dentition.



    • Body/angle fractures may affect the inferior alveolar nerve, causing numbness of the lower lip and teeth.



  • State of dentition




    • Children ages 6 to 12 will present in various states of mixed dentition. Younger children will have permanent tooth roots deep to their primary dentition. These factors will critically influence a surgeons options for reconstruction of injuries.



    • Assess for dental fracture, stability, tooth root exposure, and caries.



Pertinent imaging or diagnostic studies




  • High-resolution maxillofacial computed tomography: Gold standard for evaluation of facial trauma. Three-dimensional reconstructions may assist in evaluating injury. Maximum-intensity projection view (when available) can reveal dentition for evaluation of tooth roots.



  • Panorex: Requires patient cooperation, and patient must be upright for the study. Allows visualization of the entire mandible and dentition. Towne view adds improved evaluation of condyles.



  • Plain radiography (mandible series with anteroposterior, lateral, oblique, and open-mouth Towne view): These studies are of limited benefit in younger patients, whose skeletons are less calcified than those of adults.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Pediatric Mandible Fractures
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