Plastic Surgery Research Council
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Presenter: Darren M Smith, MD
Co-Authors: Naran S; Cray J; Bykowski M; Shakir S; Rottgers S; Losee JE
University of Pittsburgh

Background: Optimal management of pediatric mandible fractures demands preservation of this structure s growth potential and functional dynamics. We advocate less invasive interventions in dealing with these injuries whenever feasible. Here, we analyze our experience with pediatric mandible fractures at a major pediatric teaching hospital.

Methods: We assessed the demographics, management, and outcomes of pediatric mandible fractures presenting over ten years. Management was stratified as follows: Level A: physical therapy or mandible rest; Level B: external stabilization techniques (C-collar or ACE wrap); Level C: closed reduction and external fixation (CREF), and level D: open reduction and external fixation (ORIF). The effects of fracture pattern on mandibular function and growth were explored, and the impact of operative management on these relationships was assessed.

Results: 215 mandible fractures in 120 patients were analyzed (average follow-up 19.5 months, average afe 10 years). Condylar head (26%) and neck (27%) fractures were most common. Operative management (Level C or D intervention) was significantly more likely for children over 12 years of age (75.0%) than for those under 6 years of age (46.4%) (p<0.05) as well as for patients with multiple mandible fractures (50.7% versus 11.8%, respectively, p<0.05). Patients with multiply-fractured mandibles were significantly more likely (57.6%) to have an adverse outcome than patients with isolated mandible fractures (21.7%) (p<0.05). No significant growth differences were discernable between our cohort and controls on cephalometric analysis (p > 0.05).

Conclusions: Our center favors less aggressive mandible fracture treatment modalities whenever feasible. Review of our data indicates largely uncompromised mandibular function and growth with this strategy. Certain circumstances, however, do require a more invasive approach, particularly older patients and those with multiply-fractured mandibles. Longer follow-up is necessary before definitive conclusions regarding mandibular growth, development, and function after fracture can be made.

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