Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study

Bansal, Adity; Yadav, Poonam; Bhutia, Ongkila; Roychoudhury, Ajoy; Bhalla, Ashu Seith

doi:10.1016/j.jcms.2020.12.013

Cited by 19 publications

(14 citation statements)

References 60 publications

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“…We agree with Bansal et al [19] that in pediatric patients, although closed treatment could be preferred, as it preserves the soft tissue and periosteum, displaced fractures especially with co-existing condylar fractures should be treated by OR/IF.…”

Section: Discussionsupporting

confidence: 85%

Pediatric versus adult maxillofacial fractures

El‐Anwar

Elshiekh

Awad

et al. 2022

Egypt J Otolaryngol

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Objective To study, compare, and analyze the differences and the detailed features of the maxillofacial fractures in adults versus children. Patients and methods This prospective comparative study was conducted on patients who had traumatic maxillofacial fractures. Patients were categorized into 2 groups: the pediatric group and the adult group. History taking including the type of trauma, examination, computed tomography (CT) maxillofacial, fracture management, and outcome evaluation was done for all patients. Results Within included 82 patients (42 adults, 40 children), males were the most affected in adult and pediatric groups and the most affected age was between 19 and 27 years (29.2%). Motor vehicle accident (MVA) was the most common cause in both the adult group (66.66%) and the pediatric group (60%). But fall represents a significant cause in children (17.5%) with a significant difference between the two groups (p = 0.038). The mandibular fracture was the most common fracture in pediatric (65%) and adult (38.1%) groups with a significant difference between both groups regarding different sites of trauma (p = 0.017). Surgical intervention was performed in 80% of pediatric patients and 92.23% with a significant difference (p = 0.035). Conclusion MVA is the main etiology of maxillofacial fractures in children and adults, but fall is an important cause of pediatric trauma. Pediatric maxillofacial fractures below school age are a rare event with increasing incidence with age. Mandibular fractures are the most common site in the adult and pediatric populations. Most cases of maxillofacial fractures are surgically treated with OR/IF with good results but conservative management is used more in pediatric than adult fractures.

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Section: Discussionsupporting

confidence: 85%

Pediatric versus adult maxillofacial fractures

El‐Anwar

Elshiekh

Awad

et al. 2022

Egypt J Otolaryngol

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“…The qualities of titanium that make it ideal for internal fixation include its intrinsic mechanical strength, pliability, and biocompatibility (43). The long-term effects of rigid internal fixation in the growing, pediatric facial skeleton are unclear and remain a controversial subject, as some fear permanent fixation alters craniofacial growth and some studies report a higher complication rate with ORIF vs. a closed approach (44)(45)(46)(47)(48). The human medical literature reports that the intrinsic qualities of pediatric facial fractures (e.g., accelerated healing rate, skeletal growth, and bone remodeling potential) make rigid fixation with biodegradable material possible (49).…”

Section: Discussionmentioning

confidence: 99%

Craniomaxillofacial trauma in immature dogs–etiology, treatments, and outcomes

et al. 2022

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Treatment of craniomaxillofacial (CMF) trauma in dogs often requires a multidisciplinary approach and a thorough understanding of the CMF anatomical structures involved. This retrospective study aimed to utilize computed tomography (CT) studies of immature dogs evaluated for CMF trauma and to describe common fracture locations, treatment modalities, and complications, as well as the fracture healing outcomes. The medical records and CT studies of 94 dogs under 1 year of age over a 13-year period were evaluated. The skeletal location of CMF fractures, as well as the severity of displacement and fragmentation of each fracture, was recorded. Case demographic data and trauma etiology were also recorded. Animal bites accounted for the majority of trauma (71.0%). The most likely bone or region to be fractured was the maxillary bones, followed by the molar region of the mandibles. Up to 37 bones or specific regions were fractured in any given patient, with an average of 8.8 ± 3.1 fractured bones or regions per dog. Rostral mandibular trauma was associated with intra-articular fractures of the temporomandibular joint (p = 0.016). Patients sustained concomitant injuries in 32% of the cases. Muzzle therapy was the main treatment performed for most dogs (53.2%), followed by soft tissue closure (47.9%) and selective dental extractions (27.6%). Healing complications were recorded in 71.6% of the dogs, with malocclusion being the most reported complication (55.2%), and associated with dentate mandibular jaw fractures (p = 0.05). The average number of complications per dog was 2.4. No statistically significant association was found between treatment modality and healing outcome. There was a positive correlation between the severity of fracture fragmentation and displacement and a negative healing outcome (all rho >0.7). Further treatment was required in 55.6% of the dogs. Additional dental extractions were performed in 77.7% of patients. Healing complications were common in the immature CMF trauma case. Thus, the need for a comprehensive assessment of the entire CMF region during the initial visit, as well as follow-up, preferably using CT or cone beam CT, is underscored.

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“…ORIF allows a fracture to be reduced in an efficient and safe way and may be implemented even in cases where a non-surgical approach failed [ 25 , 26 ]. However, in contrast to MMF, mandible ORIF is thought to carry a higher risk of postoperative infection problems [ 27 , 28 , 29 , 30 ]. The previous arch form and facial width may not be sufficiently restored by fractured bone reduction, which causes inconsistencies between dental occlusion and bone fracture reduction [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review

et al. 2023

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Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: “what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures” and “the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars”? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

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Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study

Cited by 19 publications

References 60 publications

Pediatric versus adult maxillofacial fractures

Pediatric versus adult maxillofacial fractures

Craniomaxillofacial trauma in immature dogs–etiology, treatments, and outcomes

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review

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