Accidental and Abusive Mandible Fractures in Infants and Toddlers

Abstract

Objective: Mandible fractures are uncommon injuries in infants and young children and may raise concern for nonaccidental trauma. Our study describes several children with mandible fractures to identify features that might differentiate abuse from accident.Methods: Records and imaging were reviewed for children aged 24 months and younger who were diagnosed with mandible fractures at 2 tertiary pediatric care centers. Twenty-one cases were included, 8 of whom had formal child abuse consultations. Cases were reviewed for mechanisms of injury, physical examination findings, and occult injuries identified, as well as the final abuse determination.Results: Among children with child abuse consultations, 5 injuries (62.5%) were determined to be accidental, 1 (12.5%) was abusive, and 2 were indeterminate for abuse or accident (25%). In each accidentally injured child, the reported mechanism of injury was a short fall with evidence of facial impact. No accidentally injured child had unexpected occult injuries or noncraniofacial cutaneous injuries.Conclusions: Infants and young children can sometimes sustain mandible fractures accidentally after well-described short falls with evidence of facial impact. Abuse remains in the differential diagnosis, and children should be evaluated accordingly. We propose that accidental injury be considered when a well-evaluated child with an isolated mandible fracture has a history of a short fall.

Case of Accidental Trauma Resulting in Condylar Fractures in 3-Month-Old

“…Previous studies have reported MCF to be common in children, although it is relatively uncommon to see these injuries in infants [10][11][12]. Perhaps, owing to the elasticity of bone as well as limited mobility prior to 6 months of age, MCF have been very rarely reported in the infant age group [8,13]. Recent limited cases of MCF in infants have been included as part of case series of all pediatric patients with MCF [4,8,14].…”

“…Perhaps, owing to the elasticity of bone as well as limited mobility prior to 6 months of age, MCF have been very rarely reported in the infant age group [8,13]. Recent limited cases of MCF in infants have been included as part of case series of all pediatric patients with MCF [4,8,14].…”

“…Since MCF often present with a sublingual hematoma, Coleman's sign, a sign Case Reports in Dentistry of indirect shear forces, accidental MCF should considered in differential diagnosis, especially in an infant of this age [1][2][3]. In a recent study, 5/8 mandible fractures in children under the age of 24 months were diagnosed as accidental, and 1/6 was diagnosed as child abuse [8]. Of note, in a survey of pediatric patients with accidental trauma and NAT, NAT was more commonly associated with patients of younger age, with multiple fracture sites and with MCF [17].…”

“…While accidental MCF are common in the pediatric population, it is rare to see this injury in children under the age of two. Previous work has discussed that the work-up for accidental vs nonaccidental trauma can be challenging [ 8 ]. In this case report, we discuss the history of trauma and accidental versus nonaccidental trauma (NAT) differential diagnostic process in a 3-month-old child who presented with sublingual hematoma, a very small bruise on the chin after a trivial fall with subsequent diagnosis of bilateral MCF.…”