Self-drilling screws for the prevention of dental and skeletal injuries during open reduction and internal fixation of pediatric mandibular fractures

Facial trauma in pediatric population predisposes the child to injury of both the developing skeleton and dentition. This article aims to highlight the experience of the authors through a case report, in using self-drilling screws for fixation of mandibular fractures in pediatric age group. The use of self-drilling screws minimizes the complications such as thermal and/or mechanical damage to the developing dentition and the bone. They also provide significant advantages including ease of availability and technique, superior anchorage with primary stability, and minimizing or avoiding permanent damage to the developing tooth germs in the site of fracture. The use of self-drilling screws for mandibular open reduction and internal fixation in children is an easy, reliable, and safe technique which may have significant value addition in preventing inadvertent injury to the developing tooth germs.

The conservative treatment of mandibular fracture in a child with circummandibular wiring: case report

Maxillofacial injuries are less common in children than in adolescents and adults. This lower incidence is a result of the relatively small size of mandible, the resilient nature of the bones, and a relatively protected environment, which distinguish the treatment principles of pediatric mandibular fractures from those of the adult. The bone of child is malleable, so pediatric fractures tend to be less displaced and rarely comminuted. Moreover, high regeneration potential of the wound allows more conservative treatment modalities for the pediatric mandibular fracture. High risk of damaging unerupted tooth bud renders many clinicians to resort to more conservative treatment modality for the reduction of displaced segments. This case report describes two successful treatment cases using the circummandibular wiring which was applicated to the fracture on parasymphysis of mandible. Circummandibular wiring can protect the tooth buds, and there is no need for intermaxillary fixation so that it prevents the possible complications of intermaxillary fixation such as the temporomandibular joint ankylosis and the facial growth disturbances. The acrylic splint was removed after 3 weeks, which showed clinically good union across the fracture line without complications. They showed complete clinical and radiological bone healing with an optimum occlusion.

Clinical Analysis of Pediatric Mandibular Fractures

This retrospective study comprised 50 patients(57 fractures) with pediatric mandibular fractures sustained in various accidents and treated in the Department of Plastic and Reconstructive Surgery at the Dong-A Medical Center from September 1990 till May 2005. These patient's medical records were then retrospectively analysed in order to gain insight into a clinical pattern. 1.The seasonal and monthly incidence was the highest in Summer and August, the commonest accident time was between 12:00 p.m and 06:00 p.m. 2.The highest incidence in the age was between seven and nine years old, with male predominating over female in 1.7:1 ratio. 3.The most common cause of mandibular fractures was motor vehicle accidents followed by fall, exercise accident and others. 4.Nasal bone fracture was the commonest associate facial bone fracture. 5.Open reduction was done in 59% of total cases. 6.The cases of condyle fracture were treated with closed reduction or conservative management. Complications were malocclusion(4), TMJ limitation(2), asymmetry(2).