Pediatric Mandible Fractures


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.


  • 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.


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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