Management of Pediatric Mandible Fractures

Objectives: The use of conservative measures, mandibulomaxillary fixation (MMF), and closed reduction in children with mandible fractures has been advised due to developing dentition. Open reduction and internal fixation (ORIF) of mandible fractures with non-resorbable plates has been the preferred procedure in young children at our institution. This study evaluates the outcomes of ORIF in the management of pediatric mandible fractures. Methods: A six year retrospective chart review of children, ages 18 years and younger, treated at a tertiary pediatric hospital for mandible fractures. Demographics, fracture site, mode of treatment, and complications were evaluated. Results: A total of 303 records of children evaluated for facial fractures were reviewed. Complete records of 62 patients who suffered from a mandible fracture were identified (M = 48, F = 14, mean age = 15 years (range 2-18)). The most common fracture sites were angle (37%) and parasymphyseal (35%). Assault (53%) was the most common cause. Three patients were treated conservatively, and 1 was placed in MMF only. Fifty-eight patients (93.8%) underwent ORIF, 6 of which were placed in MMF concurrently. Average follow-up was 141 days (14-800). Complications included plate removal in 11 patients (18.9%; 6 for extruded hardware), malocclusion in 8 patients (12.9%), and infection in 1 patient. Conclusions: Management of mandibular fractures in the pediatric population can be both challenging and controversial. Many authors advocate the use of MMF whenever possible secondary to the known potential complications of ORIF. This study suggests that conservative management or ORIF of selected displaced fractures, avoiding the need for MMF, has favorable outcomes.