Management of Pediatric Mandibular Fractures Using Resorbable Plates

Chocron, Yehuda; Azzi, Alain J.; Davison, Peter G.

doi:10.1097/scs.0000000000006002

Cited by 20 publications

(11 citation statements)

References 29 publications

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“…The resorbable nature of these plates allows for anatomic reduction without restricting bone growth and eliminates secondary procedures potentially necessary for plate removal. 10,18,24,25 Resorbable plates for orbital fractures were implemented at this institution as early as 2002. However, use of resorbable plates depended largely on surgeon preference, as some surgeons prefer to use more stable titanium plates and remove the plate if necessary after fracture healing.…”

Section: Fracture Management and Outcomesmentioning

confidence: 99%

Facial Fractures and Mixed Dentition – What Are the Implications of Dentition Status in Pediatric Facial Fracture Management?

Berlin

Dalena

Oleck

et al. 2021

Journal of Craniofacial Surgery

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Introduction:The stage of maturation of the pediatric facial skeleton at the time of injury has a significant impact on both facial fracture patterns and management strategies. For instance, the relative prominence of the pediatric cranium during the early years of life affords protection to the structures of the midface, whereas delayed aeration of the frontal sinuses may predispose younger patients to frontal bone fractures. The dentition status of a pediatric patient may have similar implications in the setting of facial fracture. In this study, the authors examine the effect of dentition status on facial fracture patterns and management strategies at an urban, level 1 trauma center. Methods: A retrospective chart review was performed for all cases of facial fracture occurring in the pediatric patient population at a level 1 trauma center (University Hospital in Newark, NJ) between 2002 and 2014. A database including patient demographics, facial fracture, and concomitant injury patterns, and operative management data was constructed and analyzed. Results: A total of 72 patients with mixed dentition met inclusion criteria for our study and were compared against patients with primary (n ¼ 35) and permanent (n ¼ 349) dentition. The mean age at presentation was 9.2 years, with a male predominance of 68%. The most common fracture etiology was pedestrian struck accident (n ¼ 23), fall (n ¼ 21), motor vehicle collision (n ¼ 12), and assault (n ¼ 9). The most frequently identified facial fractures were that of the orbit (n ¼ 31), mandible (n ¼ 21), nasal bone (n ¼ 19), and frontal sinus (n ¼ 14). Additionally, 8 Le Fort and 4 nasoorbitoethmoid fractures were identified. Twenty-one patients (29%) required operative management for 1 or more facial fractures. Operative intervention was required in 38% of mandibular fractures, with 6 patients requiring only maxillomandibular fixation and 2 requiring open reduction and internal fixation with titanium plating. Nine cases of orbital fracture (29%) were managed operatively -4 with absorbable plates, 3 with Medpor implants, and 8 with titanium plating. Management of all nasal fractures requiring operative intervention was accomplished through closed reduction. Concomitant injuries included traumatic brain injury (TBI) (n ¼ 35), skull fracture (n ¼ 24), intracranial hemorrhage (ICH) (n ¼ 20), and long bone fracture (n ¼ 12). Seventeen patients required admission to the intensive care unit. Patients with mixed dentition were significantly more likely to sustain frontal sinus and Le Fort fractures (P < 0.01), as well as skull fracture, ICH, and TBI (P < 0.01) as compared to those with permanent dentition. Conclusions: The dentition status of a pediatric patient may have significant implications in both patterns of injury and operative management strategies in the setting of acute facial trauma. Our study finds that Le Fort and frontal sinus fractures were significantly more common in patients with mixed dentition. Severe concomitant injuries such as ICH and TBI were also signific...

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Section: Fracture Management and Outcomesmentioning

confidence: 99%

Facial Fractures and Mixed Dentition – What Are the Implications of Dentition Status in Pediatric Facial Fracture Management?

Berlin

Dalena

Oleck

et al. 2021

Journal of Craniofacial Surgery

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“…36,37 To date, no comparative systematic analysis has been conducted that compares the outcomes of titanium and resorbable hardware for the ORIF of pediatric mandible fractures. 38 This study aims to systematically review the studies published on outcomes of ORIF of pediatric mandible fractures, and conduct a retrospective institutional review. A comparative analysis will be performed between those treated with both types of hardware in an effort to determine which material demonstrates a superior complication profile.…”

Section: Introductionmentioning

confidence: 99%

Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

Pontell

Niklinska

Braün

et al. 2021

Craniomaxillofacial Trauma & Reconstruction

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Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990-2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1,144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; P = 0.07), and titanium hardware was more frequently removed on an elective basis (P < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (P = 0.01); whereas angle fractures were more often treated with titanium hardware (P < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference.

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“…2,4,5 In particular, mandibular condyle fractures are mainly caused by bicycle or scooter accidents and represent a common type of fracture in oral and maxillofacial surgery. [6][7][8][9] The fact, that e-scooters sharing systems have spread in major urban areas in many parts of the world during the last 2 years and numbers of patients with e-scooter related accidents are on the rise justifies further investigation. Despite currently published data about e-scooter based craniofacial injuries, few information has been published about maxillofacial fractures as, for example, mandible fractures caused by e-scooter accidents.…”

mentioning

confidence: 99%

Mandible Fractures Associated With the Introduction of an E-Scooter-Sharing System

Lentzen

Grandoch

Buller

et al. 2021

Journal of Craniofacial Surgery

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With the introduction of an e-scooter-sharing system in Germany, standing electric scooters became popular modes of transportation in many urban areas. But the increase in popularity has resulted in an increase in traumatic injuries associated with e-scooter accidents. The purpose of this investigation was to determine the common fracture pattern of patients with mandible fractures as a result of an electric scooter accident. The authors performed a retrospective investigation of 52 patients who were admitted to the trauma unit of an oral and maxillofacial department from June until November 2019 with a fracture of the mandible. Our study investigated the first 6 months of e-scooter sharing system in a major city with more than 1 million inhabitants. Our cohort consists of 52 patients, 38 males, and 14 females with a mean age of 37 years. E-scooter related mandible fractures were with 21% the third biggest group, after physical assault and falls. 45% of these patients were intoxicated by alcohol. Furthermore, the majority of e-scooter patients presented more than one fracture of the mandible (73%). For our cohort, a typical combination of a symphysis or body fracture and bilateral affected ramus and/or condyle was the prevalent recorded fracture combination (55%) of e-scooter related traumata. Small scooter wheels, a speed of 15 miles or 20 kilometers per hour and the individual clinging to the handlebar falling predestinate these vehicles for accidents with craniofacial trauma. Among all cranio-facial traumas mandible fractures were mostly documented for e-scooter accidents. The severity of e-scooter related mandible fractures and their fracture pattern should be recognized by trauma units.

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Management of Pediatric Mandibular Fractures Using Resorbable Plates

Cited by 20 publications

References 29 publications

Facial Fractures and Mixed Dentition – What Are the Implications of Dentition Status in Pediatric Facial Fracture Management?

Facial Fractures and Mixed Dentition – What Are the Implications of Dentition Status in Pediatric Facial Fracture Management?

Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

Mandible Fractures Associated With the Introduction of an E-Scooter-Sharing System

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