Resident Manual of Trauma to the Face, Head and Neck

Chapter 5: Mandibular Trauma

observing grimacing with painful stimulation. The nerve can be injured anywhere throughout its course. Three major areas of concern for facial nerve injury is to the main trunk in the region of the condylar neck, marginal mandibular nerve injury in the submandibular approach, and frontal branch injury in the preauricu- lar approach to the condyle. Facial nerve monitoring should be considered on open approaches to avoid further injury. H. Fixation Failure Fixation failure results in fracture mobility that can lead to nonunion, malunion, or infection. Causes include insufficient fixation, fracture of the plate, loosening of the screws, and devitalization of the bone around the screws (Figure 5.15). VII. Pediatric Mandibular Fractures A. Pediatric Dental and Skeletal Anatomy The dentition (Figure 5.16) and mandible (Figure 5.17) in children are very different from those in adults. Pediatric teeth have poor retentive

Figure 5.16 Differences in crown and root structure between permanent and deciduous teeth.

Figure 5.17 Differences between the adult and pediatric mandible include size, shape, and high cancellous-to-cortical ratio, making the pediatric mandible more flexible.

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