Comparative analysis of fracture characteristics of the developing mandible: The Mayo Clinic experience

Abstract Objective To review and compare the epidemiology and treatment of mandibular fractures in subgroups of a pediatric population. Methods We conducted a retrospective review of pediatric patients (age, ≤18 years) with mandibular fractures treated at our institution from January 1996 through November 2011. Results We identified 122 patients (93 [76%] male) with 216 mandibular fractures. The prevalent mechanisms of injury were motor vehicle accidents ( n = 52 [43%]), sports injuries ( n = 24 [20%]), and assault ( n = 13 [11%]). The most common fracture sites were subcondylar, parasymphyseal, angle, and body. Two patients (2%) were treated conservatively by observation only, 67 (55%) underwent maxillomandibular fixation alone, 41 (34%) underwent maxillomandibular fixation with plate fixation, and 7 (5.7%) underwent plate fixation only. The average duration of maxillomandibular fixation was 26 days (range, 7–49 days). Complications occurred in 11 patients (9.0%) over a mean follow-up of 92 days (range, 21–702 days). Fifty patients (41.0%) had comorbid conditions or a history of mental illness at the time of injury, including attention deficit hyperactivity disorder ( n = 11 [9%]), mental disorders other than attention deficit hyperactivity disorder ( n = 23 [19%]), and asthma ( n = 17 [14%]). Twenty-six patients (21%) had a history of substance use, the most common being tobacco ( n = 18 [15%]), alcohol ( n = 13 [11%]), and marijuana ( n = 11 [9%]). Conclusions Treatment approach and outcomes were affected by age and fracture characteristics. In addition, a marked proportion of this cohort had preexisting mental disorders and history of substance use, which may have implications on treatment approach.