title: Comparative analysis of fracture characteristics of the developing mandible: the Mayo Clinic experience.
abstract: OBJECTIVE
  To review and compare the epidemiology and treatment of mandibular fractures in subgroups of a pediatric population.
  
  
  METHODS
  We conducted a retrospective review of pediatric patients (age, ≤18 years) with mandibular fractures treated at our institution from January 1996 through November 2011.
  
  
  RESULTS
  We identified 122 patients (93 [76%] male) with 216 mandibular fractures. The prevalent mechanisms of injury were motor vehicle accidents (n=52 [43%]), sports injuries (n=24 [20%]), and assault (n=13 [11%]). The most common fracture sites were subcondylar, parasymphyseal, angle, and body. Two patients (2%) were treated conservatively by observation only, 67 (55%) underwent maxillomandibular fixation alone, 41 (34%) underwent maxillomandibular fixation with plate fixation, and 7 (5.7%) underwent plate fixation only. The average duration of maxillomandibular fixation was 26 days (range, 7-49 days). Complications occurred in 11 patients (9.0%) over a mean follow-up of 92 days (range, 21-702 days). Fifty patients (41.0%) had comorbid conditions or a history of mental illness at the time of injury, including attention deficit hyperactivity disorder (n=11 [9%]), mental disorders other than attention deficit hyperactivity disorder (n=23 [19%]), and asthma (n=17 [14%]). Twenty-six patients (21%) had a history of substance use, the most common being tobacco (n=18 [15%]), alcohol (n=13 [11%]), and marijuana (n=11 [9%]).
  
  
  CONCLUSIONS
  Treatment approach and outcomes were affected by age and fracture characteristics. In addition, a marked proportion of this cohort had preexisting mental disorders and history of substance use, which may have implications on treatment approach.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Siwani
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tombers
authors.affiliation: Division of Oral Diagnosis and Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Rieck
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: cofer.shelagh@mayo.edu.
authors.forename: Shelagh A
authors.initials: SA
authors.lastname: Cofer
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000293:Adolescent; D017677:Age Distribution; D001249:Asthma / Q000453:epidemiology; D001265:Athletic Injuries / Q000453:epidemiology; D001860:Bone Plates; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008337:Mandibular Fractures / Q000453:epidemiology* / Q000601:surgery*; D001523:Mental Disorders / Q000453:epidemiology; D008910:Minnesota / Q000453:epidemiology; D009104:Multiple Trauma / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D017678:Sex Distribution; D014754:Violence / Q000706:statistics & numerical data
keywords: Fractures, bone; Mandible; Pediatrics