title: An Alternative Method of Intermaxillary Fixation for Simple Pediatric Mandible Fractures.
abstract: OBJECTIVE
  Mandibular fractures represent a substantial portion of facial fractures in the pediatric population. Pediatric mandibles differ from their adult counterparts in the presence of mixed dentition. Avoidance of injury to developing tooth follicles is critical. Simple mandibular fractures can be treated with intermaxillary fixation (IMF) using arch bars or bone screws. This report describes an alternative to these methods using silk sutures and an algorithm to assist in treating simple mandibular fractures in the pediatric population.
  
  
  METHODS
  A retrospective chart review was performed and the records of 1 surgeon were examined. Pediatric patients who underwent treatment for a mandibular fracture in the operating room from 2011 to 2015 were identified using Common Procedural Terminology codes. Data collected included age, gender, type of fracture, type of treatment used, duration of fixation, and presence of complications.
  
  
  RESULTS
  Five patients with a mean age of 6.8 years at presentation were identified. Fracture types were unilateral fractures of the condylar neck (n = 3), bilateral fractures of the condylar head (n = 1), and a unilateral fracture of the condylar head with an associated parasymphyseal fracture (n = 1). IMF was performed in 4 patients using silk sutures, and bone screw fixation was performed in the other patient. No post-treatment complications or malocclusion were reported. Average duration of IMF was 18.5 days.
  
  
  CONCLUSIONS
  An algorithm is presented to assist in the treatment of pediatric mandibular fractures. Silk suture fixation is a viable and safe alternative to arch bars or bone screws for routine mandibular fractures.
authors.affiliation: Resident, Division of Plastic and Reconstructive Surgery, Washington University, St Louis, MO. Electronic address: sfarber5@gmail.com.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Farber
authors.affiliation: Resident, Division of Plastic and Reconstructive Surgery, Washington University, St Louis, MO.
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Nguyen
authors.affiliation: Assistant Professor, Department of Oral Maxillofacial Surgery, Washington University, St Louis, MO.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Harvey
authors.affiliation: Assistant Professor, Division of Plastic and Reconstructive Surgery, Washington University, St Louis, MO.
authors.forename: Kamlesh B
authors.initials: KB
authors.lastname: Patel
mesh_terms: D000465:Algorithms; D001642:Bicycling / Q000293:injuries; D001860:Bone Plates; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D003766:Dental Occlusion; D003818:Dentition, Mixed; D005260:Female; D005500:Follow-Up Studies; D018460:Fractures, Comminuted / Q000628:therapy; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries; D008337:Mandibular Fractures / Q000628:therapy*; D012189:Retrospective Studies; D047011:Silk; D013537:Sutures
chemical_list: D047011:Silk