An intraoral approach to minimize morbidity in a pediatric trauma case
Downloads
Background: Maxillofacial fractures are rare in children. The treatment of fractures in children differs from that of adults due to the growth process of the jaw and dental development. The intraoral approach does not result in facial scars or nerve injury. Furthermore, it allows direct visualization of occlusion confirmation during the plate placement. Purpose: This case report describes a pediatric comminuted mandibular fracture that underwent open reduction with an intraoral approach. Case: A 13-year-old boy with a mandibular fracture was referred by the neurosurgery department. Clinical examination found a hematoma in the left submental region and discontinuity of the mandibular symphysis without a wound in the extraoral region. Coleman's sign and a vertical step between teeth 41 and 31 and teeth 33 and 34 with anterior open bite were found intraorally. A CT scan disclosed more than two fracture lines that involved the mandibular symphysis and a basal triangle fracture. The patient was diagnosed with a symphysis mandibular comminuted fracture with open bite malocclusion. Case management: Open reduction and reconstruction plate placement with an intraoral approach was performed under general anesthesia. The patient had no complaints during the two-month evaluation, and the plate was planned for removal in the third month postoperatively. Conclusion: In this case, open reduction with an intraoral approach was able to restore bone architecture without functional or aesthetic complications. This may be because the patient could be treated like an adult, as he had almost reached skeletal maturity due to his age. However, periodic observation is necessary to evaluate jaw growth.
Downloads
Ferreira PC, Barbosa J, Braga JM, Rodrigues A, Silva ÁC, Amarante JM. Pediatric facial fractures: a review of 2071 fractures. Ann Plast Surg. 2016; 77(1): 54–60. doi: https://doi.org/10.1097/SAP.0000000000000346
Gopinath AK, Das JR, Panicker P, Narayanan A. Open reduction and internal fixation in pediatric mandibular fractures: a report of 10 cases and review of literature. Kumar A, editor. Int J Oral Care Res. 2016; 4(March): 11–5. doi: https://doi.org/10.5005/jp-journals-10051-0004
Kao R, Rabbani CC, Patel JM, Parkhurst SM, Mantravadi A V, Ting JY, Sim MW, Koehler K, Shipchandler TZ. Management of mandible fracture in 150 children across 7 years in a US Tertiary Care Hospital. JAMA Facial Plast Surg. 2019; 21(5): 414–8. doi: https://doi.org/10.1001/jamafacial.2019.0312
Fernández EC, Moreira EM, Martínez AP. Mandible fracture in children: a case report. South Sudan Med J. 2020; 13(3): 116–9. web: https://www.ajol.info/index.php/ssmj/article/view/198722
Nazir A, Imtiaz M, Gull A, Pervaiz R, Zahra T, Kiran S, Jawa ZA, Akhtar MU. Causes, pattern and management of pediatric mandibular fractures. Pakistan Oral Dent J. 2020; 40(3): 139–44. web: https://podj.com.pk/index.php/podj/article/view/569
Bansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS. Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study. J Craniomaxillofac Surg. 2021; 49(3): 196–205. doi: https://doi.org/10.1016/j.jcms.2020.12.013
Lee K, Yoon K, Park K-S, Cheong J, Shin J, Bae J, Ko I, Park H. Treatment of extensive comminuted mandibular fracture between both mandibular angles with bilateral condylar fractures using a reconstruction plate: a case report. J Korean Assoc Oral Maxillofac Surg. 2014; 40(3): 135–9. doi: https://doi.org/10.5125/jkaoms.2014.40.3.135
Cleveland CN, Kelly A, DeGiovanni J, Ong AA, Carr MM. Maxillofacial trauma in children: Association between age and mandibular fracture site. Am J Otolaryngol. 2021; 42(2): 102874. doi: https://doi.org/10.1016/j.amjoto.2020.102874
Gunardi OJ, Diana R, Kamadjaja DB, Sumarta NPM. Closed reduction in the treatment of neglected mandibular fractures at the Department of Oral and Maxillofacial Surgery, Universitas Airlangga. Dent J. 2019; 52(3): 147–53. doi: https://doi.org/10.20473/j.djmkg.v52.i3.p147-153
Zhou W, An J, He Y, Zhang Y. Analysis of pediatric maxillofacial trauma in North China: Epidemiology, pattern, and management. Injury. 2020; 51(7): 1561–7. doi: https://doi.org/10.1016/j.injury.2020.04.053
Allred LJ, Crantford JC, Reynolds MF, David LR. Analysis of pediatric maxillofacial fractures requiring operative treatment. J Craniofac Surg. 2015; 26(8): 2368–74. doi: https://doi.org/10.1097/SCS.0000000000002087
Sheikhi M, Ghazizadeh M, Salehi MM. Posttraumatic mandibular asymmetry presenting in a young adult. Radiol Case Reports. 2017; 12(1): 73–7. doi: https://doi.org/10.1016/j.radcr.2016.10.023
Wolfswinkel EM, Weathers WM, Wirthlin JO, Monson LA, Hollier LH, Khechoyan DY. Management of pediatric mandible fractures. Otolaryngol Clin North Am. 2013; 46(5): 791–806. doi: https://doi.org/10.1016/j.otc.2013.06.007
Sharma S, Mohammad S, Kanna S, Gupta R, Kharmawlong RW. Comminuted mandibular fractures in a pediatric patient: a case report with review. The Traumaxilla. 2020; 2(1–3): 36–9. doi: https://doi.org/10.1177/26323273211073777
Samieirad S, Khajehahmadi S, Tohidi E, Pakravan M. A conservative method for treating severely displaced pediatric mandibular fractures: an effective alternative technique. J Dent Mater Tech. 2016; 5(2): 53–8. web: https://jdmt.mums.ac.ir/article_6613.html
Schenkel JS, Obwegeser J, Zemann W, Rostetter C, Tandon R, Metzler P. Outcome of comminuted mandibular fracture repair using an intraoral approach for osteosynthesis. J Craniofac Surg. 2014; 25(6): 2033–7. doi: https://doi.org/10.1097/SCS.0000000000001103
Nezam S, Kumar A, Shukla JN, Khan SA. Management of mandibular fracture in pediatric patient. Natl J Maxillofac Surg. 2018; 9(1): 106–9. doi: https://doi.org/10.4103/njms.NJMS_54_17
Bharadwaj V. Management of compound mandibular fractures with miniplate and monocortical screws in 8-year-old male child : a case presentation. Int J Sci Res. 2022; 11(11): 803–6. doi: https://doi.org/10.21275/SR221112120620
Aizenbud D, Hazan-Molina H, Emodi O, Rachmiel A. The management of mandibular body fractures in young children. Dent Traumatol. 2009; 25(6): 565–70. doi: https://doi.org/10.1111/j.1600-9657.2009.00815.x
Kim T-W, Seo E-W, Song S-I. Open reduction and internal fixation of mandibular fracture in an 11-month-old infant: a case report. J Korean Assoc Oral Maxillofac Surg. 2013; 39(2): 90–3. doi: https://doi.org/10.5125/jkaoms.2013.39.2.90
Bobrowski AN, Torriani MA, Sonego CL, Carvalho PH deA, Post LK, Chagas Júnior OL. Complications associated with the treatment of fractures of the dentate portion of the mandible in paediatric patients: a systematic review. Int J Oral Maxillofac Surg. 2017; 46(4): 465–72. doi: https://doi.org/10.1016/j.ijom.2016.12.010
Chrcanovic BR. Open versus closed reduction: comminuted mandibular fractures. Oral Maxillofac Surg. 2013; 17(2): 95–104. doi: https://doi.org/10.1007/s10006-012-0349-2
Gandhi G, Sharma A, Soodan KS, Patidar D. Mandibular fracture in children: a new approach for management and review of literature. Int J Clin Pediatr Dent. 2019; 12(4): 356–9. doi: https://doi.org/10.5005/jp-journals-10005-1643
Fardhani A, Rizqiawan A, Mulyawan I, Anugraha G. Comparison outcome of open and close reduction treatments for parasymphysis mandibular fractures. Dent J. 2023; 56(4): 268–72. doi: https://doi.org/10.20473/j.djmkg.v56.i4.p268-272
Daniels JS, Albakry I, Braimah RO, Samara MI. Maxillofacial bone fractures in children and adolescents: overview of 247 cases in a Major Referral Hospital, Najran, Kingdom of Saudi Arabia. Craniomaxillofac Trauma Reconstr. 2021; 14(2): 126–34. doi: https://doi.org/10.1177/1943387520952680
Sharma A, Jadhav A, Bhola N, Gupta C, Gupta A. Managing a grossly comminuted and infected mandibular fracture using mandibular reconstruction plate system. J Datta Meghe Inst Med Sci Univ. 2021; 16(4): 789–91. doi: https://doi.org/10.4103/jdmimsu.jdmimsu_419_21
de Carvalho MF, Hardtke LAP, de Souza MFC, de Oliveira Araujo V. Comminuted mandibular fracture in child victim of dog bite. Dent Traumatol. 2012; 28(4): 324–8. doi: https://doi.org/10.1111/j.1600-9657.2011.01079.x
Sheta MS, Shoushan MM, Hussein MM, Abd Elaal SE. Evaluation of using microplates osteosynthesis for pediatric mandibular fractures. Tanta Dent J. 2015; 12(3): 149–55. doi: https://doi.org/10.1016/j.tdj.2015.01.002
Khokhar M, Sadhwan BS, Tailor SS. Comparison of intra-oral and extra-oral approaches in mandibular angle fractures. Natl J Clin Orthop. 2022; 6(3): 01–3. doi: https://doi.org/10.33545/orthor.2022.v6.i2a.365
Copyright (c) 2025 Dental Journal
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
- Every manuscript submitted to must observe the policy and terms set by the Dental Journal (Majalah Kedokteran Gigi).
- Publication rights to manuscript content published by the Dental Journal (Majalah Kedokteran Gigi) is owned by the journal with the consent and approval of the author(s) concerned.
- Full texts of electronically published manuscripts can be accessed free of charge and used according to the license shown below.
- The Dental Journal (Majalah Kedokteran Gigi) is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License
