2015 HSC Section 1 Book of Articles

Facial Fractures in Children

generally not included children, but given the rapid bone healing of children, the findings of these studies should translate well to the pediatric population. 51,52

Mandibular Fractures Mandible fractures are commonly reported as the most frequent facial fracture seen in children, and many more may go undiagnosed. 18,53,54 The management of pediatric mandibular fractures presents several challenges related to unerupted teeth, tempo- romandibular joint dysfunction, and facial growth disturbances. In children, not every fracture needs an open reduction and internal fixation. Instead, the surgeon must contemplate the interplay of fracture location to bony growth and dental development, and chose an intervention that lessens the potential for long-term impairment and deformity ( Fig. 3 ). In contrast to adults, many pediatric mandibular fractures can be treated with conservative measures, such as soft diet alone. The condyle is the most frequently injured portion of the mandible. 54 However, the location of the condylar fracture changes with age, because children younger than 5 years are more likely to sustain condylar head fractures, whereas older adolescents are more likely to sustain condylar neck fractures. 55,56 Symphaseal fractures are the second most commonly seen in all age groups. 57 However, as adolescents get older mandibular fracture patterns begin to resemble adult fractures and body and angle fractures can be encountered. 57 In very young children, fractures that are nondisplaced and that do not affect dental occlusion can be treated with soft diet. 3,57 Noncompliance with diet restrictions is less of a problem in children than adults, since parents can control the child’s diet. Many nondisplaced condylar fractures can therefore be treated with this conservative approach. However, displaced fractures of the condyle should undergo closed reduc- tion. 1,22,57 Intermaxillary fixation can then be applied to further stabilize the fractured segments; however, only a brief period (7–10 days) of intermaxillary fixation is recom- mended because prolonged intermaxillary fixation can cause severe ankylosis in children. 1,3,57,58

Fig. 3. Algorithm for the treatment of mandible fractures in children. These are general considerations and may not be appropriate for all patients. The degree of fracture displace- ment necessitates consideration of a more aggressive fixation approach. CR, closed reduc- tion; IDW, interdental fixation; IMF, intermaxillary fixation; ORIF, open reduction internal fixation.

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