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Resident Manual of Trauma to the Face, Head, and Neck

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Chapter 5: Mandibular Trauma

b. Panorex

Panorex is difficult in the critically injured and uncooperative. It is the

study of choice for mandible fractures.

c. CT Scanning

CT scanning provides a thin cut with three-dimensional and multiplanar

reconstructions. It is especially useful for TMJ evaluation.

d. Occlusal Views

Occlusal views are used for evaluating symphyseal displacement.

e. Periapical Radiographs

Periapical radiographs are used for evaluating root and alveolar

fractures.

2. Treating Pediatric Mandibular Fractures

The general management principles for treating pediatric mandibular

fractures are similar to those for adults, but differ because of the mixed

dentition. Restoration of occlusion, function, and facial balance is

required for successful treatment. The developmental growth of the

child’s face must be taken into consideration.

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Proper treatment may

prevent complications, such as growth disturbance and infection.

Younger than 2 years

—Before age 2, a child’s jaws are often edentu-

lous. Mandibular fracture would require an acrylic splint fixed with

circummandibular wires. If immobilization of the jaw is necessary, the

splint may be fixed to both occlusive surfaces, with both circumman-

dibular wires and wires through the pyriform aperture.

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6–12 years

—At ages 2–5 years, deciduous teeth are present and

conical in shape (Figure 5.17). Interdental wiring may be used for

fixation. Arch bars are difficult to secure below the gum line, and may

require resin to attach wire for fixation.

6–12 years

—In this age group, the mixed dentition, primary teeth are

resorbing and often are loose. In, children 5–8 years, deciduous

molars may be used for fixation, and in children 7–11 years, the

primary molars and incisors may be used for fixation. When dentition

is not available, splints may be used.

9–12 years

—In this age group, MMF using arch bars is possible,

because enough permanent dentition is present.

Healing in children is rapid and often requires 10–20 days of immobili-

zation. Delay in treatment may require callus removal for proper

reduction. When ORIF is necessary the use of monocortical screws

should be considered at the inferior mandibular border to prevent

damage to developing permanent dentition. Resorbable polylactic and