Plastic Surgery Research Council

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Pediatric Mandible fractures - Determinants of Early Repair at US Trauma Centers
Selim G. Gebran, MD1, Philip J. Wasicek, MD2, Adekunle Elegbede, MD, PhD3, Ledibabari M. Ngaage, MB BChir4, Yuanyuan Liang, PhD5, Marcus Ottochian, MD6, Jonathan J. Morrison, PhD, MBBS6, Michael P. Grant, MD, PhD1, Yvonne M. Rasko, MD4, Arthur J. Nam, MD, MS1, Fan Liang, MD1.
1Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA, 2Department of General Surgery, University of Maryland School of Medicine, Baltimore, MD, USA, 3Department of Plastic and Reconstructive Surgery, The Johns Hopkins University, Baltimore, MD, USA, 4Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine, Baltimore, MD, USA, 5Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA, 6Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.

BACKGROUND:Pediatric mandibular fracture management is one of the most challenging topics within craniofacial trauma, with significant variation in treatment algorithms. Specifically, indications for open, closed, and non-surgical management are actively contested in the context of a growing skeleton with non-erupted dentition. Here, we describe national statistics on patterns of injury, timing, and course of treatment for pediatric mandibular fractures.
METHODS:The National Trauma Data Bank was used to examine demographics and clinical characteristics of patients 18 years and younger, admitted to US trauma centers between 2007 and 2015. Mandibles fractures, interventions, and in-hospital outcomes at the index admission were abstracted using ICD-9 and Abbreviated Injury Score (AIS) codes. A multivariate analysis was used to determine independent predictors for repair.
RESULTS:A total of 19,032 patients met inclusion criteria. The median age of patients was 16 years (IQR: 11-17), with a male predominance (M:F ratio 2.8:1). Children younger than 5 years old had mandible fractures mostly due to falls (38.6%), while adolescents (13-18 years old) were more likely to have mandibular fractures from MVC (25.7%) or assault (36.5%). There was a positive correlation between the rate of multiple fractures and increasing age (22.4%-37.5%). Condyle fractures were observed predominantly in infants and toddlers younger than 1 year of age (50.3%, vs 22.6% overall), while multiple fractures of the mandible, body and angle fractures occurred mostly in adolescents (37.5%, 29.7% and 20.2% respectively). Across fracture types, operative management with closed reduction was similar among the different age groups while the rates of repair via open reduction were higher with increasing age (P<0.001) (Figure 2). Rigid fixation with plate and screws (titanium or resorbable) was used in only 7.4% of open reductions, similarly across age groups (P= 0.619). Patients with isolated symphysis fractures and those with multiple mandibular fractures were most likely to receive surgical repair (P<0.001), and the most likely among patients who underwent surgical repair to undergo open reduction rather than closed reduction (P<0.001) (Table 3, Figure 3).
CONCLUSIONS:Evaluation of pediatric facial fracture management patterns from the National Trauma Data Bank demonstrates primarily non-operative early management for most pediatric mandibular fractures. Operative rates increase with advancing age and are highest among those with isolated symphysis and multiple mandibular fractures.





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