doi:10.1016/S0531-5131(03)01130-0
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Contents
1. Introduction
This retrospective study reviews the treatment of mandibular fractures in children between March 1994 and January 2001 in our department. Records of 19 children presenting 30 mandibular fractures were reviewed with a mean time of follow-up of 22 months. Age, sex, cause, type of fractures, associated injuries, methods of treatment and complications were recorded (Tables 1–3). According to the development of dentition, we divide our population into two groups (group A from 2 to 11 years, and group B from 12 to 18 years). The ratio of boys to girls was 2/1; traffic and bicycle accidents were the main causes of these fractures. Mandibular fractures were multiple in 50% of the cases, and the condyle alone was involved in 16% of the cases. Isolated fractures of the condyloid joint were treated conservatively; miniplates, osteosynthesis and intermaxillary fixation were used in the other cases (Table 4). No retarded facial growth was observed and functional mobility was not significantly reduced. Ankylosis of the temporomandibular joint occurred in only one patient. One case of definitive damage to the cervical spine was recorded.
| Etiologies | |||
|---|---|---|---|
| Traffic accident | Falls | Aggression | Ill treatment |
| 9 | 6 | 2 | 1 |
| Age (years) | Closed reduction (%) | MMF (%) | OR+MMF (%) | Kinesitherapy (%) |
|---|---|---|---|---|
| 0–11 | 50 | 17 | 33 | |
| 12–18 | 8 | 16 | 46 | 30 |
| Sites | Closed reduction (%) | MMF (%) | OR+MMF (%) | Kinesitherapy (%) |
|---|---|---|---|---|
| Body | 12 | 24 | 64 | |
| Condyle | 25 | 75 | ||
| Body+Condyle | 100 |
2. Background
The aim of this study was to record the mechanism of mandibular fractures in children to underline the importance of protection methods and to search for prognosis factors.
3. Methods
All children with mandibular fractures treated in our department from March 1994 to January 2001 were retrospectively reviewed. We counted 19 children: 7 girls and 12 boys from 18 months to 18 years. We divided this population into two groups: group A from 18 months to 11 years in lacteal or mixed dentition, and group B from 12 to 18 years in definitive dentition. We recorded age, sex, etiologies, type of fractures, associated injuries, methods of treatment and complications. The long-term follow-up was 22 months.
4. Results
In group A, we found six patients with a total of ten 10 mandibular fractures. The ratio of boys to girls was 1.3:1, and the common etiology was bicycle and common falls (no child wore helmets or other protections). In this group, there was no articular fracture but one case of serious cervical rachidian fracture with paraplegia as consequence.
In group B, we had 13 patients with a total of 20 mandibular fractures. The ratio of boys to girls was 2.4:1. The mean cause of the traumatism was traffic accident. Mandibular fractures were usually numerous; associated injuries and complications, mostly benign, were frequent.
A total of 83.5% of the complications happened in group B due to traffic accidents (children being passengers without seat belts).
5. Conclusion
The mandible in children is characterized by a high cancellous to cortical bone ratio, giving more elasticity to the bone than in adults. Mandibular fractures in children are generally treated conservatively and a long-term follow-up is important to prevent orthodontic problems. The high osteogenic potential of the pediatric mandible is responsible for a low complication rate. Prognosis factors of secondary complications are the age (>12 years old), the mechanism (traffic accident) and the associated injuries (rachidian fracture). Mandibular fractures in young children are always a factor of the gravity of the facial traumatism. Prevention by safety belts, safety seats and helmets is essential.