PEDIATRIC MANDIBLE FRACTURES: PRESENTATION, MANAGEMENT, AND EARLY FOLLOW-UP
Darren M. Smith, MD, Alex Rottgers, MD, Joseph Madia, BS, Sanjay Naran, BS, Lisa Vecchione, DMD, MDS, Gary DeCesare, MD, Michael Bykowski, MS, BPhil, Joseph E. Losee, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
Pediatric mandible fractures are rare events, and account for a lower proportion of craniofacial fractures than they do in adults. In addition to necessitating attention to the mandible’s potential for future growth and development, the management of pediatric mandible fractures is complicated by the mandible’s status as the only dynamic component of the pediatric facial skeleton. Suboptimal management therefore can lead to substantial morbidity ranging from growth disturbances to functional impairment. We present our extensive experience at a major metropolitan teaching hospital with regard to demographics, pathology, treatment modalities employed, and early outcomes in the management of pediatric mandible fractures.
Patients with available electronic medical records presenting to the emergency department and seen in our craniofacial clinic with at least one follow-up visit from 2000 through 2007 were included. Demographics, mechanism of injury, fracture type, treatment modality, and outcomes were recorded. A database was established that will serve as the basis for collecting and analyzing long-term outcomes data.
Over 2000 pediatric craniofacial fractures were captured in our database, including 108 mandible fractures in 65 patients. Average follow-up was 14.7 months (range 0.2 to 80 months). The most common mechanism of injury was a fall (44.6%). The most common fracture type was a parasymphaseal fracture (26.9% of all fractures). 55.4% of patients underwent operative management of a mandible fracture. 67.7% of patients were reported to achieve uncompromised mandible and TMJ function after trauma. In the 44 patients for whom this metric was available, average maximal incisive opening was 41.3. (standard deviation 7.4). The most common suboptimal outcomes were TMJ click and new class 2 occlusion; each occurring in 6 patients. 66.7% of all suboptimal outcomes occurred in patients undergoing operative management of their mandible fracture.
While our conservative approach to these injuries has yielded largely uncompromised mandibular function and growth at early follow-up, long-term data is required before definitive recommendations can be made. However, even at this early stage, several recommendations can be offered based on our experience. First, conservative management is advisable: operative intervention is to be avoided whenever possible. If surgery is required, the least invasive approach should be favored. When performing ORIF, tooth buds must be avoided. Finally, surgeons treating these injuries must be committed to a comprehensive 18 year treatment plan including annual evaluations enhanced by cephalograms, dedicated mandibular films, and photographic documentation.