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Alhabshi MO, Taweel DM, Alahmary HM, Al-Suhaymi OH, Al-Bander MR, Al-Suroor TA, Al-Shahrani AM, Alshallaa BH, Bakhamis BA. The Role of Orthodontics in the Management of Maxillofacial Fractures in Children: A Review on Contemporary Approaches. Cureus 2024; 16:e63128. [PMID: 39055419 PMCID: PMC11271819 DOI: 10.7759/cureus.63128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Maxillofacial fractures present complex challenges requiring effective orthodontic management to restore function and aesthetics. This review explores various orthodontic techniques, including fixed braces, maxillomandibular fixation (MMF), functional orthodontic therapy (FOT), and acrylic splints, emphasizing their roles in stabilizing fractures and promoting healing. The management of condylar fractures is discussed, highlighting the benefits of early intervention with functional appliances to facilitate condylar remodeling in children and adolescents. Additionally, the review covers splinting methods for dental and dentoalveolar fractures and the use of open reduction internal fixation (ORIF) for maxillary fractures. It addresses the complications and challenges of fracture management, the need for a multidisciplinary approach, and the limitations of current studies. Future directions include the use of advanced technologies such as virtual surgical planning (VSP) and 3D printing to enhance treatment precision and outcomes. This review provides a comprehensive overview of orthodontic strategies for maxillofacial fractures, offering insights into clinical applications and future advancements.
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Affiliation(s)
- Manaf O Alhabshi
- Oral and Maxillofacial Surgery, King Abdullah Medical City, Jeddah, SAU
| | | | | | | | | | | | | | | | - Bushra A Bakhamis
- General Dentistry, Armed Forces Hospitals Administration in Taif Region, Taif, SAU
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Sudduth JD, Byrd R, Marquez JL, Bautista CH, Chen J, Battistini A, Yamashiro DK, Gociman B. Pediatric Mandibular Fracture Management: Intraoperative Thermoplastic Splint Fabrication and Circummandibular Wires, without Maxillomandibular Fixation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5883. [PMID: 38855133 PMCID: PMC11161274 DOI: 10.1097/gox.0000000000005883] [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] [Received: 03/14/2024] [Accepted: 04/24/2024] [Indexed: 06/11/2024]
Abstract
Management of mandibular fractures often involves the use of maxillomandibular fixation (MMF) to attain immobility of the fractured segments. This can be used as a primary treatment modality or as an adjunct in fracture management. This technique, however, has its drawbacks due to the great burden of care imposed on patients. In the following case, fixation of a pediatric open mandibular body fracture was attained without the use of MMF, and bone union was achieved. Due to age, safety concerns, long-distance travel, and parent's preference, the routine management of this type of fracture with MMF using piriform aperture drop wires and circummandibular wires was not done. Instead, the fracture was reduced, and an intraoral mandibular impression was taken in the operating room, which was used to create a stone model. A 2-mm acrylic splint was designed and fabricated from the stone model, and two circummandibular wires were placed. The wires were tightened over the acrylic splint to achieve stabilization of the mandibular reduction. At 4 weeks postoperatively, the splint was removed, and the patient was maintained on a soft diet. At 6 weeks, bone union was appreciated clinically by immobility of the mandibular segments, and the patient was advanced to a regular diet. Occlusion was corrected to premorbid state by clinical findings and 6 months postoperative imaging. This technique represents an effective approach in managing pediatric mandibular fractures when MMF cannot be used.
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Affiliation(s)
- Jack D Sudduth
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Richard Byrd
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jessica L Marquez
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Catherine H Bautista
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joanna Chen
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrea Battistini
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Duane K Yamashiro
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Barbu Gociman
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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Ragit R, Fulzele PR, Wadewale SN, Bhola N, Solanki DR, Thosar NR. Conservative Management of Maxillary and Mandibular Fractures in a Pediatric Patient With a Modified Open Cap Splint: A Case Report. Cureus 2024; 16:e55191. [PMID: 38558710 PMCID: PMC10980854 DOI: 10.7759/cureus.55191] [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: 12/05/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Pediatric maxillofacial fractures, which are not very prevalent, account for around 5% of all face injuries. Children under the age of 13 are more susceptible to craniofacial injuries because they have a larger cerebral mass-to-body ratio than adults. The fracture pattern in children does not resemble that of adults, due to which the treatment of pediatric fractures differs from that of adults and can pose substantial difficulties to the pediatric dentist due to many factors, including the complex anatomy of the developing jaw. In this case report, a 5-year-old male patient presented with an injury to the upper and lower jaw. A case was managed with a conservative approach by using a modified open cap splint. A radiographic investigation, including CT brain and face, was done, which revealed the mandibular symphyseal fracture, bilateral condyle, and right Lefort II fracture. A modified open cap splint was fabricated and fixed with circummandibular and circumzygomatic wiring under general anesthesia. After two months, the fractured site showed good healing on orthopantomography (OPG), and satisfactory occlusion was achieved. The patient was kept on monthly follow-ups for up to five months. Treatment guidelines for pediatric maxillary and mandibular fractures are different from those for adults in that most pediatric cases are managed by a conservative approach. Cap splints are a versatile treatment option for juvenile mandibular fractures because they can be used to restore function and aesthetics with minimal morbidity, do not impede jaw growth or the development of dentition, and can be applied to patients of a wider range of ages.
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Affiliation(s)
- Rutuja Ragit
- Pediatric and Preventive Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Punit R Fulzele
- Pediatric and Preventive Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sanjana N Wadewale
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitin Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dhruvi R Solanki
- Pediatric and Preventive Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nilima R Thosar
- Pediatric and Preventive Dentistry, Sharard Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Quinto JHS, Bachesk AB, Nogueira LC, Filho LI. An Alternative Approach Using Circummandibular Wiring for Treatment of Dentoalveolar Fractures in Children: A Case Report. Craniomaxillofac Trauma Reconstr 2022; 15:169-174. [DOI: 10.1177/1943387521990283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The prevalence of dentoalveolar injuries in children is approximately 25%, with falls from own height being one of the main etiologies. Diagnosis is based on the clinical evaluation associated with complementary imaging tests. The treatment of choice depends on the type of damage and structure affected. For alveolar process fractures, closed reduction and semi-rigid dental splinting for 4 to 6 weeks is generally satisfactory. However, some cases, such as severe segmental fractures, require open treatment to ensure adequate reduction and stabilization of the displaced alveolar segment, which is usually achieved by titanium miniplates and screws. Nevertheless, there are situations where this type of fixation is not possible, requiring alternative methods. Therefore, this article describes a surgical technique performed by open reduction, associating semi-rigid dental splint and circummandibular wiring in pediatric patient diagnosed with dentoalveolar fracture through clinical examination (with bone fracture displacement) and tomography. The technique promoted a good prognostic to the patient, proving to be a viable alternative for treating dentoalveolar fractures.
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Affiliation(s)
- José Henrique Santana Quinto
- Department of Dentistry, Oral and Maxillofacial Surgery, São Paulo University, Ribeirão Preto, São Paulo, Brazil
| | - Andressa Bolognesi Bachesk
- Department of Dentistry, Oral and Maxillofacial Surgery, State University of Maringá, Maringá, Paraná, Brazil
| | - Lucas Costa Nogueira
- Department of Dentistry, Oral and Maxillofacial Surgery, São Paulo University, Ribeirão Preto, São Paulo, Brazil
| | - Liogi Iwaki Filho
- Department of Dentistry, Oral and Maxillofacial Surgery, State University of Maringá, Maringá, Paraná, Brazil
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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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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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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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Ramanathan M, Panneerselvam E, Krishna Kumar Raja V. 3D planning in mandibular fractures using CAD/CAM surgical splints — A prospective randomized controlled clinical trial. J Craniomaxillofac Surg 2020; 48:405-412. [DOI: 10.1016/j.jcms.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/18/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022] Open
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Bobrowski A, Torriani M, Sonego C, Carvalho PD, Post L, Chagas Júnior O. Complications associated with the treatment of fractures of the dentate portion of the mandible in paediatric patients: a systematic review. Int J Oral Maxillofac Surg 2017; 46:465-472. [DOI: 10.1016/j.ijom.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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A Simplified Way for the Stabilization of Pediatric Mandibular Fracture With an Occlusal Splint. J Craniofac Surg 2016; 27:e363-4. [DOI: 10.1097/scs.0000000000002617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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