Minimally Invasive Surgical Management of Complex Pediatric Facial Fractures

Mckenzie, Jamie; Nguyen, Edward

doi:10.1177/24727512211022601

Cited by 6 publications

(10 citation statements)

References 17 publications

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“…Circum-zygomatic fixation along with closed reduction offers a conservative alternative to conventional surgical care in lowering the possibility of postoperative complications. Because of poor retention due to conical-shaped teeth, dental spacing, and partially erupted teeth, IMF with an open reduction to correct occlusion and facial fractures, yields poor results in the primary or mixed dentition and also has the potential for tooth avulsion [12]. Therefore, in this case, a noninvasive approach was taken.…”

Section: Discussionmentioning

confidence: 99%

“…A nonoperative method, however, is not an option when the fracture is complicated with highly movable or displaced segments and associated with orbital dystopia and malocclusion. A minimally invasive approach uses the inherent osteogenic potential of the bone to optimize healing, thereby allowing the reduction and stabilization of fractures [12]. Ensuring satisfactory outcomes on both aesthetic and functional bases necessitates long-term follow-up in the case of pediatric patients with facial fractures [2].…”

Section: Discussionmentioning

confidence: 99%

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Conservative Management of Maxillary and Mandibular Fractures in a Pediatric Patient With a Modified Open Cap Splint: A Case Report

Ragit,

Fulzele,

Wadewale

et al. 2024

Cureus

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Pediatric maxillofacial fractures, which are not very prevalent, account for around 5% of all face injuries. Children under the age of 13 are more susceptible to craniofacial injuries because they have a larger cerebral mass-to-body ratio than adults. The fracture pattern in children does not resemble that of adults, due to which the treatment of pediatric fractures differs from that of adults and can pose substantial difficulties to the pediatric dentist due to many factors, including the complex anatomy of the developing jaw. In this case report, a 5-year-old male patient presented with an injury to the upper and lower jaw. A case was managed with a conservative approach by using a modified open cap splint. A radiographic investigation, including CT brain and face, was done, which revealed the mandibular symphyseal fracture, bilateral condyle, and right Lefort II fracture. A modified open cap splint was fabricated and fixed with circummandibular and circumzygomatic wiring under general anesthesia. After two months, the fractured site showed good healing on orthopantomography (OPG), and satisfactory occlusion was achieved. The patient was kept on monthly follow-ups for up to five months. Treatment guidelines for pediatric maxillary and mandibular fractures are different from those for adults in that most pediatric cases are managed by a conservative approach. Cap splints are a versatile treatment option for juvenile mandibular fractures because they can be used to restore function and aesthetics with minimal morbidity, do not impede jaw growth or the development of dentition, and can be applied to patients of a wider range of ages.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Conservative Management of Maxillary and Mandibular Fractures in a Pediatric Patient With a Modified Open Cap Splint: A Case Report

Ragit,

Fulzele,

Wadewale

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…Thorough literature search revealed just 1 case report where a complex Le Fort II and III fracture was managed by a retention modified occlusal splint stabilized with circumzygomatic wiring for a 3-week period. 8 In our case we used the modified open cap splints stabilized by circumzygomatic wiring for the management of bilateral Le Fort I fracture. This treatment modality provides a conservative operative approach, achieving excellent functional and cosmetic results without the potential morbidity of a more invasive surgery.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Management of pediatric Le Fort and mandibular fracture with a modified cap splint

Mathura,

Bhola,

Agarwal

et al. 2024

F1000Res

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Pediatric facial fractures are rare and make up 5–15% of all facial fractures. The low incidence of facial fractures among children is due to physiological and environmental factors such as greater resilience of the pediatric skeleton, higher bone to tooth ratio, direct parental supervision and limited outdoor activity.1 In children of 5–10 years of age nasal fractures are by far the most frequent (58.6%), followed by mandibular fractures (21.5%). Orbital (9.5%), frontal (5.1%), and midfacial (3.8%) fractures are next in frequency2. Le Fort fractures are very rare in children, and there is a paucity of literature presenting their frequency and characteristics. In the mandible condylar fracture is the most common (38.9%) followed by angle (20.6%), parasymphysis (18.3%), body (15.3%) and symphysis (5.3%).3 Facial fractures are more common in boys, though this varies greatly from 1.1:1 to 8.5:1.4 The majority of facial fractures in children result from falls (7.8–48%) and sports-related injuries (4.4–42%).5 In primary or mixed dentition, the placement of internal fixation hardware is challenging due to the risk of injuring unerupted permanent tooth follicles. The use of resorbable plates and screws offer a potential solution to the growing pediatric facial bone as the standard titanium fixation systems carry the risk of translocation, growth restriction, and dental injury. Dental splinting or suspension wires can also be used in place of direct plating. Fortunately, mild malocclusion at this age has the potential to be improved through bony remodeling, the eruption of permanent dentition, compensation of the mastication mechanism, and posttraumatic orthodontia.6 Accordingly, the goal of treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion with minimal residual functional and esthetic impairment.

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“…As a result, most craniofacial departments have a higher threshold for operating on such patients, with the majority of patients approximately 70% being managed conservatively; nonetheless, operational management increases with age and fracture severity. Circum-zygomatic closure reduction is a conservative approach to typical surgical care that reduces the risk of perioperative complications while allowing patients to tolerate and comply with the procedure (22).…”

Section: Managementmentioning

confidence: 99%

Epidemiology, Classification and Management of Zygomatic Fractures Among Children

Bukhsh¹,

Majrashi²,

AL‐Mutairi³

et al. 2022

JOHS

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The zygomatic bone, which includes the lateral and inferior orbital rims as well as the malar eminence, comprises the lateral part of the midface, giving it width and projection. Zygomatic arch fractures account for 10% to 15% of all facial fractures and are commonly caused by a direct blow to the face. Zygomatic fractures are most caused by blunt trauma. Paediatric zygomatic fractures are a rare complication in the continuum of craniofacial injuries that cosmetic and reconstructive surgeons deal with. The combination between etiology, force of damage, and stage of craniofacial development determines the location and distribution of facial fractures in children. The purpose of this research is to review the available information about the epidemiology, classification and management of zygomatic fractures in children. Although facial fractures especially zygomatic fractures in children are quite uncommon and rare, appropriate screening and diagnosis, as well as prompt treatment, are necessary to avoid consequences. Surgeons face tremendous hurdles when dealing with facial trauma associated with serious injuries, as there is a functional and aesthetic impact on the growing children, as well as a financial and emotional burden on the patient and family. The early management of zygomatic fractures in children, like any trauma, detects situations that require rapid treatment to avoid life-threatening consequences. Paediatric zygomatic fractures are quite uncommon due to the specific anatomic, physiologic, social, and environmental aspects that accompany craniofacial growth however the literature data is lacking and quite scarce, more epidemiological studies targeting age group of children are needed.

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Minimally Invasive Surgical Management of Complex Pediatric Facial Fractures

Cited by 6 publications

References 17 publications

Conservative Management of Maxillary and Mandibular Fractures in a Pediatric Patient With a Modified Open Cap Splint: A Case Report

Conservative Management of Maxillary and Mandibular Fractures in a Pediatric Patient With a Modified Open Cap Splint: A Case Report

Case Report: Management of pediatric Le Fort and mandibular fracture with a modified cap splint

Epidemiology, Classification and Management of Zygomatic Fractures Among Children

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