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Panneerselvam E, Ravikumar C, Rajan TA, Balasubramanian S, Krishnakumar Raja VB. Management of multiple and displaced mandibular fractures in a pediatric patient sans mandibular immobilization, sans open reduction and internal fixation. Chin J Traumatol 2024:S1008-1275(24)00031-2. [PMID: 38531714 DOI: 10.1016/j.cjtee.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/12/2023] [Accepted: 02/18/2024] [Indexed: 03/28/2024] Open
Abstract
Maxillofacial fractures in the pediatric population are generally managed by conservative approaches such as soft diet and medication or semi-invasive procedures namely inter-maxillary fixation or circum-mandibular wiring. These approaches are preferred over any invasive treatment to minimize injury to the growing skeleton and tooth germs. Displaced fractures that cause functional problems such as restricted mouth opening, malocclusion or impaired breathing, mandate open reduction and internal fixation. However, surgical management is associated with morbidity related to general anesthesia, risk of injury to vital structures, and potential, skeletal or dental growth disturbances. This case report describes a non-invasive method of managing displaced, multiple fractures of the mandible in a pediatric patient, with the use of low intensity pulsed ultrasound to achieve favorable clinical outcomes and nil complications. Neither immobilization of the mandible with inter-maxillary fixation nor open reduction and internal fixation was used. Low intensity pulsed ultrasound therapy is painless and patient-friendly.
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Affiliation(s)
- Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India.
| | - Chandini Ravikumar
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India
| | - Trishala Annamalai Rajan
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India
| | - Sasikala Balasubramanian
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India
| | - V B Krishnakumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India
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Bressler S, Morris L. Pediatric Head and Neck Trauma. Otolaryngol Clin North Am 2023; 56:1169-1182. [PMID: 37460373 DOI: 10.1016/j.otc.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The pediatric patient population has unique anatomic characteristics that bring challenges and increased risk to management. The purpose of this article is to guide the head and neck trauma surgeon in decision making for the treatment of pediatric head and neck trauma with an emphasis on facial fracture management.
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Affiliation(s)
- Sara Bressler
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA
| | - Lisa Morris
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA.
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Trauma Surgery. J Oral Maxillofac Surg 2023; 81:E147-E194. [PMID: 37833022 DOI: 10.1016/j.joms.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Hajibandeh J, Peacock ZS. Pediatric Mandible Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:555-562. [PMID: 37517978 DOI: 10.1016/j.coms.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
The management of pediatric facial fractures requires several considerations by the treating surgeon. Pediatric facial fractures occur less commonly than in adults. Among fracture patterns in children, studies have repeatedly demonstrated that mandible fractures are the most common facial fracture particularly the condyle. Most fractures in children are amenable to nonsurgical or closed treatment; however, certain indications exist for open treatment. The literature describing epidemiology, treatment trends, and long-term outcomes are limited in comparison with adult populations. The purpose of the article is to review the etiology, workup, and management of mandible fractures in children.
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Affiliation(s)
- Jeffrey Hajibandeh
- Massachusetts General Hospital, Division of Oral & Maxillofacial Surgery, Warren 1201, 55 Fruit Street, Boston, MA 02127, USA.
| | - Zachary S Peacock
- Massachusetts General Hospital, Division of Oral & Maxillofacial Surgery, Warren 1201, 55 Fruit Street, Boston, MA 02127, USA
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Morrison KA, Flores RL. A novel treatment of pediatric bilateral condylar fractures with lateral dislocation of the temporomandibular joint (TMJ) using transfacial pinning. Case Reports Plast Surg Hand Surg 2023; 10:2242498. [PMID: 37547270 PMCID: PMC10402857 DOI: 10.1080/23320885.2023.2242498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
A 3-year-old patient sustained a tripartite mandibular fracture, including bilateral condylar fractures with lateral dislocation of the left condyle and symphyseal fracture. Staged lower jaw reconstruction with closed reduction of the laterally dislocated condyle, transfacial pinning between the mandibular angles, MMF using circummandibular wiring and intermaxillary fixation screws was performed.
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Affiliation(s)
- Kerry A. Morrison
- Hansjörg Wyss Department of Plastic Surgery, NY University Langone Health, New York, NY, USA
| | - Roberto L. Flores
- Hansjörg Wyss Department of Plastic Surgery, NY University Langone Health, New York, NY, USA
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Morisada MV, Tollefson TT, Said M, Hwang J, Hsieh TY, Funamura JL. Pediatric Mandible Fractures: Mechanism, Pattern of Injury, Fracture Characteristics, and Management by Age. Facial Plast Surg Aesthet Med 2022; 24:375-381. [DOI: 10.1089/fpsam.2022.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Megan V. Morisada
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Travis T. Tollefson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Mena Said
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Joshua Hwang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Tsung Yen Hsieh
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jamie L. Funamura
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
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Highland J, Dunya G, Teames C, Peacock J, Yamashiro D, Muntz H, Park A. Customizable interdental splinting for repair of pediatric mandibular fractures in children with mixed dentition: A novel technique. Int J Pediatr Otorhinolaryngol 2022; 157:111133. [PMID: 35462217 DOI: 10.1016/j.ijporl.2022.111133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/27/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Repair of pediatric mandibular fractures (PMFs) can be challenging due to the lack of permanent dentition for immobilization, and the presence of unerupted teeth and growth plates in the mandible limiting the space for fixation. Interdental splinting (IDS) has been advocated to provide temporary fixation without the need for mandibular plating; however, there is sparse description of the surgical methodology, and data on long term outcomes are even more limited. The aim of this study is to present our technique and outcomes using a novel technique for IDS repair of pediatric mandible fractures. STUDY DESIGN Observational retrospective chart review. SETTING Tertiary care pediatric hospital. SUBJECTS AND METHODS Pediatric patients requiring operative repair for mandibular fracture at our tertiary care institution between 2004 and 2021 were included. Patients over 18 years of age, those who died due to associated injuries, or those who underwent non-IDS repairs were excluded. Subjects with at least 3 months of follow-up were assessed for efficacy of surgical repair and short-term adverse outcomes, and at least 1 year for long-term adverse events. Descriptive statistics were obtained. RESULTS Twenty-three children were included in the study with an average age of 7.4 years (range 2-17 years). Fifty-two percent (52.2%) were female. The most common fracture site was the condyle, occurring in 16 children (70%). The indication for operative repair in all cases was malocclusion. The average duration of maxillomandibular fixation (MMF) with the novel IDS was 21 days (range 12-42 days). The average length of follow up was 1.6 years (range 3 months-11 years). All children had restored, functional occlusion at follow up with none requiring further orthodontic or dental intervention. Three children of the total cohort (13.0%) had prolonged hospitalization beyond 48 h for poor oral intake. Five children (21.7%) experienced minor long-term complications including persistent temporomandibular joint pain (n = 1, 4.3%), infection (n = 2, 8.7%), hypertrophic scar (n = 1, 4.3%) and exposure of hardware (n = 1, 4.3%). CONCLUSION PMFs resulting in malocclusion are safely and effectively managed with operative repair utilizing a customizable IDS, with few observed short- and long-term complications.
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Affiliation(s)
- Julie Highland
- Division of Otolaryngology, University of Utah Health, 50N Medical Drive, SOM 3C120, Salt Lake City, UT, 84132, United States.
| | - Gabriel Dunya
- Division of Otolaryngology, University of Utah Health, 50N Medical Drive, SOM 3C120, Salt Lake City, UT, 84132, United States
| | - Charles Teames
- University of Utah School of Medicine, Eccles Health and Sciences Building, Suite 5900, 26 South 2000 East, Salt Lake City, UT, 84112, United States
| | - Jordan Peacock
- University of Utah School of Medicine, Eccles Health and Sciences Building, Suite 5900, 26 South 2000 East, Salt Lake City, UT, 84112, United States
| | - Duane Yamashiro
- Division of Plastic Surgery, University of Utah Health, 30N 1900 E, 3B400, Salt Lake City, UT, 84132, United States
| | - Harlan Muntz
- Division of Otolaryngology, University of Utah Health, 50N Medical Drive, SOM 3C120, Salt Lake City, UT, 84132, United States
| | - Albert Park
- Division of Otolaryngology, University of Utah Health, 50N Medical Drive, SOM 3C120, Salt Lake City, UT, 84132, United States
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Mandibular Body Fractures. Facial Plast Surg Clin North Am 2021; 30:99-108. [PMID: 34809890 DOI: 10.1016/j.fsc.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fractures of the mandibular body most commonly occur after interpersonal violence or motorized vehicle accident but can occur in athletes. Mandibular body fractures are often associated with additional mandibular fractures. The treatment goal is to achieve preinjury occlusion and facial appearance, and this can be done via a closed reduction and maxillomandibular fixation or open reduction and fixation with or without maxillomandibular fixation. The authors present 3 cases in this article.
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Combined Symphyseal and Condylar Fractures: Considerations for Treatment in Growing Pediatric Patients. Plast Reconstr Surg 2021; 148:51e-62e. [PMID: 34076622 DOI: 10.1097/prs.0000000000008055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Combined symphyseal-condylar mandible fractures are relatively common but difficult to manage in children. This study investigated the cause and management of symphyseal-condylar fractures in pediatric patients. METHODS This study presents a retrospective review and expert opinion of pediatric symphyseal-condylar mandibular fracture management at the authors' institution between 1990 and 2019. National data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (2000 to 2016) were used to determine whether institutional data had national applicability. RESULTS Twenty-one patients at the authors' institution met inclusion criteria. Of these patients, 26.7 percent of deciduous dentition patients underwent open reduction and internal fixation, 40 percent underwent closed treatment (maxillomandibular fixation), and 33.3 percent received a soft diet. All mixed dentition patients underwent open reduction and internal fixation or closed treatment; all permanent dentition patients underwent open reduction and internal fixation. The national database (n = 1708) demonstrated similar treatment patterns: most permanent dentition patients (88.7 percent) underwent open reduction and internal fixation, most mixed dentition patients (79.2 percent) underwent closed treatment, and among deciduous dentition patients, 53.5 percent patients received a soft diet; 38 percent received closed treatment. In this study, the overall posttreatment complication rate was 62.5 percent among open reduction and internal fixation patients, 14.3 percent among closed treatment patients, and 16.7 percent among patients treated with a soft diet. CONCLUSIONS Symphyseal-condylar mandibular fractures were associated with substantial morbidity in children. The authors created a treatment algorithm to maximize outcomes in children who suffer from this challenging fracture pattern. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Rodrigues MTV, Schueng FEA, Mendes BC, Vale DS, Souza FGD, Nóia CF. A Simple Method of Transoperative Maxillomandibular Fixation in Pediatric Facial Fractures. J Craniofac Surg 2021; 32:e375-e376. [PMID: 33252522 DOI: 10.1097/scs.0000000000007279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Maxillomandibular fixation in pediatric facial fractures is quite challenging to be achieved, especially in mid-mixed dentition. Traditional well established intermaxillary devices have a lot of limitations in these patients. This article presents a case of a 9-year-old female patient with a displaced mandibular fracture in which orthodontic buttons were used for transoperative maxillomandibular fixation followed by internal fixation after adequate occlusion reestablishment and fracture reduction. The method showed high efficacy and celerity, allowing the success of treatment, with satisfactory evolution of the patient.
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Affiliation(s)
| | - Filipe E A Schueng
- Department of Dentistry, São Lucas University Center- UNISL, Porto Velho
| | - Bruno Coelho Mendes
- Department of Diagnosis and Surgery, Araçatuba School of Dentistry, São Paulo State University- UNESP, Araçatuba
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Abdelhalim MM, El Fahar MH. Novel and Affordable Low-Cost Technique for Fixation of Parasymphyseal Fractures in Infants With Unerupted Dentition. J Oral Maxillofac Surg 2021; 79:1732.e1-1732.e6. [PMID: 33775652 DOI: 10.1016/j.joms.2021.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Pediatric mandibular fractures are immensely challenging compared to adult fractures. The current update management spectrum ranges from the conservative one in the form of soft diet and regular follow-up, or less invasive surgical intervention by closed reduction and nonrigid fixation, to open reduction and internal fixation with plates and screws. In this study, we investigated the use of a straightforward fabricated mold for the parasymphyseal mandibular fracture in infants with an unerupted dentition. PATIENTS AND METHODS This prospective study was conducted on 8 infants presenting with parasymphyseal fractures with unerupted dentitions in our specialized trauma center. In the operating room before the induction of anesthesia, the authors used a straightforward plastic airway to create a splint. The curved part was split into 2 transverse halves making 2 U-shaped curved pieces that were utilized as a mold. Intraoperatively, the U-shaped piece was placed over the mandible and stabilized with circummandibular wires. This molded airway is used to stabilize the fracture site for 2-3 weeks. The average period of follow-up was around 6 months. RESULTS The average time of mandibular fixation was 17.6 ± 2.4 SD (14 to 20) days. The mean of the total operative time was 38.7 ± 3.5 SD minutes, ranging from 35 to 45 minutes. Our infants were observed in the outpatient clinic for 6 months postoperatively during the follow-up period. There were no noticeable complications nor any interference with tooth eruption or mandibular growth. CONCLUSIONS The results of this study suggest that this technique is straightforward to use and affordable. It does not require a long learning period. It also exhibits the advantage of reducing the cost in many developing countries.
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Cleveland CN, Kelly A, DeGiovanni J, Ong AA, Carr MM. Maxillofacial trauma in children: Association between age and mandibular fracture site. Am J Otolaryngol 2021; 42:102874. [PMID: 33418178 DOI: 10.1016/j.amjoto.2020.102874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the association between age and location of facial fractures in the pediatric population. MATERIALS AND METHODS A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) from the 2016 Kids' Inpatient Database (KID) in children aged ≤18 years was conducted. International Statistical Classification of Diseases, 10th Revision (ICD-10) codes were used to extract facial fracture diagnoses. Logistic regression was used to evaluate and compare the contribution of various demographic factors among patients who had different types of facial fractures. RESULTS A total of 5568 admitted patients were identified who sustained any type of facial bone fracture. Patients who had facial fractures were significantly more likely to be male (68.2% versus 31.8%; p<0.001) and were older with a mean age of 12.86 years (95% confidence interval [CI]: 12.72-12.99). Approximately one-third of patients with a facial fracture had a concomitant skull base or vault fracture. Maxillary fractures were seen in 30.9% of the cohort while mandibular fractures occurred in 36.9% of patients. The most common mandibular fracture site was the symphysis (N=574, 27.9% of all mandibular fractures). Condylar fractures were more common in younger children while angle fractures were more common in teenagers. Regression analysis found that age was the only significant contributor to the presence of a mandibular fracture (β=0.027, p<0.001) and race was the only significant contributor to maxillary fractures (β=-0.090, p<0.001). CONCLUSIONS Facial fractures increase in frequency with increasing age in children. The mandible was the most commonly fractured facial bone, with an age-related pattern in fracture location.
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Lodhi TG, Patil SB, Bahetwar SK, Nimonkar PV, Peter BK, Sharma AB. Management of Fracture Mandible by Open Occlusal Acrylic Splint in Pediatric Patients: A Case Series. Int J Clin Pediatr Dent 2021; 14:812-815. [PMID: 35110876 PMCID: PMC8783219 DOI: 10.5005/jp-journals-10005-2099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aim and objective The aim of this article is to report the treatment management of fracture mandible in pediatric patients by a simple, noninvasive, and conservative method. Treatment of a pediatric patient with a mandibular fracture is one of the most challenging jobs. In adults, the treatment of the mandibular fracture is a surgical intervention by open reduction and fixation but it is not usual in the case of children due to the anatomy of growing mandible and deciduous teeth, presence of underlying erupting permanent teeth, and incomplete ossification of jawbones. In pediatric patients, the main concern in the treatment of the mandibular fracture is the normal growth and development of mandibular bone. So, in this case series, the treatment of the children who got mandibular fracture were done by a simple, time saving and noninvasive procedure by the fabrication of open occlusal splint retained by circummandibular wiring which did not interfere with the growth and development of mandible. How to cite this article Lodhi T, Patil SB, Bahetwar SK, et al. Management of Fracture Mandible by Open Occlusal Acrylic Splint in Pediatric Patients: A Case Series. Int J Clin Pediatr Dent 2021;14(6):812–815.
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Affiliation(s)
- Tulsi G Lodhi
- Department of Plastic, Reconstructive and Maxillofacial Dentistry, Government Medical College and Hospital, Nagpur, Maharashtra, India
- Tulsi G Lodhi, Department of Plastic, Reconstructive and Maxillofacial Dentistry, Government Medical College and Hospital, Nagpur, Maharashtra, India, Phone: +91 7620619629, e-mail:
| | - Surendrakumar B Patil
- Department of Plastic, Reconstructive and Maxillofacial Dentistry, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Surendrakumar K Bahetwar
- Department of Pediatric and Preventive Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Pranali V Nimonkar
- Department of Trauma Care Center, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Bhumika K Peter
- Department of Orthodontics, Bhaba Dental College and Research Center, Bhopal, Madhya Pradesh, India
| | - Aparna B Sharma
- Department of Plastic, Reconstructive and Maxillofacial Dentistry, Government Medical College and Hospital, Nagpur, Maharashtra, India
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Bansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS. Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study. J Craniomaxillofac Surg 2021; 49:196-205. [PMID: 33483246 DOI: 10.1016/j.jcms.2020.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/17/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to compare the outcome and complications of open reduction and internal fixation (ORIF) with closed treatment, as well as to review the literature. This was a retrospective study on pediatric patients with mandible fracture. The primary objective was a comparison of outcomes in terms of bone healing, maximal incisal opening (MIO), and occlusion, and the secondary objective was to review complications. A total of 77 pediatric patients (age <12 years) were managed with closed treatment and 23 with ORIF. In all, 62 patients were found with a single fracture (22 patients with parasymphysis fracture and 21 with condyle fracture, followed by symphysis, angle, and body fracture) and 38 patients with more than one fracture, with symphysis and bilateral condyle fracture being the most common. Bone healing was observed in all the patients. Mean MIO was 26.9 ± 2.8 mm and 29.3 ± 1.7 mm in the closed and ORIF group, respectively, and the difference was statistically nonsignificant (p = 0.5). One patient (1.3%) had deranged occlusion, and mobility was observed in one patient (1.3%) in the closed treatment group. Infection and nerve paresthesia were not seen in any patient at follow-up. Although closed treatment is preferred, as it preserves the soft tissue and periosteum, a displaced mandible fracture especially with co-existing condylar fracture should be treated by ORIF.
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Affiliation(s)
- Adity Bansal
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Yadav
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajoy Roychoudhury
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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Kao R, Rabbani CC, Patel JM, Parkhurst SM, Mantravadi AV, Ting JY, Sim MW, Koehler K, Shipchandler TZ. Management of Mandible Fracture in 150 Children Across 7 Years in a US Tertiary Care Hospital. JAMA FACIAL PLAST SU 2020; 21:414-418. [PMID: 31169865 DOI: 10.1001/jamafacial.2019.0312] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pediatric mandible fractures are the most common pediatric facial fracture requiring hospitalization, but data are lacking on management methods, outcomes, and complications. Objective To analyze management methods, outcomes, and complications of pediatric mandible fractures at an urban academic tertiary care center. Design, Setting, and Participants Single-institution cohort study conducted at 2 urban level 1 pediatric trauma centers including all patients aged 0 to 17 years diagnosed with mandible fractures between January 1, 2010, and December 31, 2016. Fractures were treated by multispecialty surgical teams. Data were analyzed between January 1, 2018, and March 1, 2018. Main Outcomes and Measures Fracture distributions, mechanisms, treatment methods, complications, and follow-up. Results Of 150 patients with 310 total mandible fractures, the mean (SD) age was 12.8 (4.6) years; 108 (72.0%) were male; 107 (71.3%) were white; and 109 (72.7%) had 2 or more mandible fractures. There were 78 condylar or subcondylar fractures (60 patients), 75 ramus or angle fractures (69 patients), 69 body fractures (62 patients), 78 symphyseal or parasymphyseal fractures (76 patients), and 10 coronoid fractures (10 patients). The most common mechanisms of injury were assault and battery, motor vehicle collisions, falls or play, and sports-related mechanisms. Thirty-eight (25%) patients were treated with observation and a soft diet. Children 12 years and older were more likely to receive open reduction internal fixation (ORIF) (P = .02). Of 112 patients treated with surgery, 63 (56.2%) were treated with maxillomandibular fixation (MMF), 24 (21.4%) received ORIF, and 20 (17.9%) received both MMF and ORIF. Nonabsorbable plating was used in all but 1 of the ORIF procedures. Five of 44 (11.4%) patients receiving ORIF or ORIF and MMF had follow-up beyond 6 months, and 8 of the 44 (18.2%) had documented plating hardware removal; hardware was in place for a mean (SD) 180 (167) days. Sixty of the 150 patients (40.0%) had some form of follow-up, a mean (SD) 90 (113) days total after initial presentation. Thirteen patients experienced complications, for a total complication rate of 8.7%. Conclusions and Relevance Conservative management, using MMF and a soft diet, was favored for most operative pediatric mandible fractures. Open reduction internal fixation with titanium plating was less commonly used. Outcomes were favorable despite a lack of consistent follow-up. Level of Evidence 4.
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Affiliation(s)
- Richard Kao
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Cyrus C Rabbani
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Janaki M Patel
- Medical Student, Indiana University School of Medicine, Indianapolis
| | - Samantha M Parkhurst
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Avinash V Mantravadi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Michael W Sim
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Karl Koehler
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Taha Z Shipchandler
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
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López-Santacruz HD, Flores-Velázquez J, Rosales-Berber MÁ. Mandibular greenstick fracture healing: A conservative approach. PEDIATRIC DENTAL JOURNAL 2019. [DOI: 10.1016/j.pdj.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.
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Affiliation(s)
- Brent B Pickrell
- Division of Plastic Surgery, Harvard Medical School, Boston, Massachusetts
| | | | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Lee SH, Yun SJ, Ryu S, Choi SW, Kim HJ, Kang TK, Oh SC, Cho SJ. Brain Computed Tomography Compared with Facial 3-Dimensional Computed Tomography for Diagnosis of Facial Fractures. J Pediatr 2017; 184:32-37.e2. [PMID: 28190518 DOI: 10.1016/j.jpeds.2017.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/30/2016] [Accepted: 01/12/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To compare the detection of facial fractures and radiation dose between brain computed tomography (CT) and facial 3-dimensional (3D) CT in pediatric patients who have experienced a trauma. STUDY DESIGN Four hundred pediatric patients who experienced a trauma and underwent immediate brain CT and facial 3D CT between January 2016 and June 2016 were included in this retrospective study. Two reviewers independently analyzed and determined the presence of the facial fractures of 8 anatomic regions based on brain CT and facial 3D CT over a 1-week interval. Suggested treatment decisions for facial fractures seen on brain CT and facial 3D CT were evaluated by one physician. The facial 3D CT scans, interpreted by a senior radiologist, were considered as the reference standard. Diagnostic performance, radiation dose, and interobserver agreement of the CT scans were evaluated. RESULTS Brain CT showed a high sensitivity (94.1%-96.5%), high specificity (99.7%-100%), and high accuracy (98.8%-99.0%) in both reviewers, and performed as well as did facial 3D CT (P ≥ .25). The suggested treatment decision was not different between the brain CT and facial 3D CT findings. The agreements between the reference standard and the reviewers, and between reviewers 1 and 2 were excellent (k = 0.946-0.993). The mean effective radiation doses used in brain CT (3.6 mSv) were significantly lower than those in brain CT with facial 3D CT (5.5 mSv) (P < .001). CONCLUSIONS Brain CT showed acceptable diagnostic performance and can be used as the first-line imaging tool in the workup of pediatric patients with suspected facial fractures.
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Affiliation(s)
- Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Chungcheongbuk-do, Republic of Korea.
| | - Seokyong Ryu
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Seoung Won Choi
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Hye Jin Kim
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Tae Kyug Kang
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Sung Chan Oh
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Suk Jin Cho
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
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