The pediatric mandible: II. Management of traumatic injury or fracture.
OBJECTIVE
After studying this article, the participant should be able to: 1. Describe the changing epidemiology of mandibular fractures in children and adolescents. 2. Discuss the appropriate use of internal fixation in the treatment of pediatric mandibular fractures. 3. Describe the difficulties posed by the deciduous dentition in the use of interdental wiring. 4. Understand reasons why techniques specific to adult fractures may not be applicable to the growing mandible. 5. Understand the etiology and epidemiology of pediatric mandibular fractures. 6. Understand the reasons for conservative (closed) versus aggressive (open) treatment of mandibular injury.


BACKGROUND
Fractures of the pediatric mandible are complicated by the anatomic complexity of the developing mandible, particularly by the presence of tooth buds and the eruption of deciduous and permanent teeth. Traditional methods of fracture reduction and fixation employed in adults have little applicability in the pediatric population.


METHODS
The authors describe the surgical techniques that have been used at their institution and those that can be used safely in the pediatric setting.


RESULTS
In most cases, "conservative" management is the preferred option, especially in the treatment of condylar fractures. In cases requiring surgical intervention, interdental wiring, drop wires in combination with circummandibular wires, and acrylic splints are suited well to specific phases of dental maturation.


CONCLUSIONS
Open reduction and internal fixation using monocortical screws and microplates or resorbable plates and screws are acceptable techniques in the pediatric patient, but they require special safeguards. Algorithms are presented to simplify management of these complicated injuries.
Smartt
James M
JM
Division of Plastic Surgery, Department of Surgery, The University of Pennsylvania Medical Center, The Children's Hospital of Philadelphia, Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, PA 19104, USA.
Low
David W
DW
Bartlett
Scott P
SP
D000293:Adolescent; D000465:Algorithms; D001860:Bone Plates; D001863:Bone Screws; D001864:Bone Wires; D002648:Child; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008337:Mandibular Fractures / Q000453:epidemiology / Q000601:surgery*; D013165:Splints