Raysa Cabrejo, BA1, Sabine Egeler, MD2, Michael Alperovich, MD1, Samuel Lin, MD, MBA2.
1Yale Medical School, New Haven, CT, USA, 2Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Pediatric mandible fractures: current management practices
Mandible fractures are the most common type of facial fracture in children, but still rare. Mandibular fractures can be treated either in a closed or open manner. The majority of published articles recommend closed reduction treatment of mandible fractures in the pediatric population.
The Kid's Inpatient Database from the Healthcare Cost and Utilization Project was analyzed over 15 consecutive years, ranging 1997-2012. Binomial logistic regressions were conducted to analyze the factors involved in determining open or closed treatment of the fracture. The factors analyzed were: age, gender, fracture site, fracture type, intracranial injury, cervical spine injury, and whether intubation necessary due to the facial fracture.
A weighed total of 30,846 encounters were found to have a mandible fracture in the database. In children that were edentulous, had primary dentition or had mixed dentition the most common fracture was at the condyle followed by the symphysis. In children with secondary dentition, the most common fracture site was the angle followed by symphysis. In females, the most common location was the symphysis at 9.1% and in males the most common location was the angle at 14.7%. About 78% of all mandible fractures were closed fractures compared to 70% treated in an open manner. Mandible fractures that were open had an odd ratio of 1.69 of having open treatment. Patients necessitating intubation due to the facial injuries or intracranial injury had a higher odd ratio (1.22 and 1.48, respectively) to having open treatment. Patients that had symphysis or multiple mandible fractures had a 1.41 and 1.37 odds ratio of having open treatment, respectively. Age had an odd ratio of 1.09 of having open treatment.
This study represents the largest study to date regarding the incidence, demographics, and surgical treatment of mandible fractures. The most common mandible fracture in children, younger than 7 years of age, is in the condyle and most commonly found in males, which matches previous publications. Overall, there seems to be many recommendations to perform closed reductions whenever possible. The minority of mandible fractures in children younger than 7, about 20%, were open fractures yet the data demonstrates that about half of fractures were treated in an open manner. Open treatment increases the risk of complications and long-term consequences in the facial development of children. Therefore, this study demonstrates a need for more evidence-based treatment guidelines of pediatric mandible fractures.
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