HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Reprinted by permission of JAMA Facial Plast Surg. 2019 Jun 6. doi: 10.1001/jamafacial.2019.0312. [Epub ahead of print].

Research

JAMA Facial Plastic Surgery | Original Investigation

Management of Mandible Fracture in 150 Children Across 7 Years in a US Tertiary Care Hospital

Richard Kao, MD; Cyrus C. Rabbani, MD; Janaki M. Patel, BS; Samantha M. Parkhurst, BS; Avinash V. Mantravadi, MD; Jonathan Y. Ting, MD, MBA; Michael W. Sim, MD; Karl Koehler, PhD; Taha Z. Shipchandler, MD

IMPORTANCE Pediatric mandible fractures are the most common pediatric facial fracture requiring hospitalization, but data are lacking on management methods, outcomes, and complications.

OBJECTIVE To analyze management methods, outcomes, and complications of pediatric mandible fractures at an urban academic tertiary care center.

DESIGN, SETTING, AND PARTICIPANTS Single-institution cohort study conducted at 2 urban level 1 pediatric trauma centers including all patients aged 0 to 17 years diagnosed with mandible fractures between January 1, 2010, and December 31, 2016. Fractures were treated by multispecialty surgical teams. Data were analyzed between January 1, 2018, and March 1, 2018.

MAIN OUTCOMES AND MEASURES Fracture distributions, mechanisms, treatment methods, complications, and follow-up.

RESULTS Of 150 patients with 310 total mandible fractures, the mean (SD) age was 12.8 (4.6) years; 108 (72.0%) were male; 107 (71.3%) were white; and 109 (72.7%) had 2 or more mandible fractures. There were 78 condylar or subcondylar fractures (60 patients), 75 ramus or angle fractures (69 patients), 69 body fractures (62 patients), 78 symphyseal or parasymphyseal fractures (76 patients), and 10 coronoid fractures (10 patients). The most common mechanisms of injury were assault and battery, motor vehicle collisions, falls or play, and sports-related mechanisms. Thirty-eight (25%) patients were treated with observation and a soft diet. Children 12 years and older were more likely to receive open reduction internal fixation (ORIF) ( P = .02). Of 112 patients treated with surgery, 63 (56.2%) were treated with maxillomandibular fixation (MMF), 24 (21.4%) received ORIF, and 20 (17.9%) received both MMF and ORIF. Nonabsorbable plating was used in all but 1 of the ORIF procedures. Five of 44 (11.4%) patients receiving ORIF or ORIF and MMF had follow-up beyond 6 months, and 8 of the 44 (18.2%) had documented plating hardware removal; hardware was in place for a mean (SD) 180 (167) days. Sixty of the 150 patients (40.0%) had some form of follow-up, a mean (SD) 90 (113) days total after initial presentation. Thirteen patients experienced complications, for a total complication rate of 8.7%. CONCLUSIONS AND RELEVANCE Conservative management, using MMF and a soft diet, was favored for most operative pediatric mandible fractures. Open reduction internal fixation with titanium plating was less commonly used. Outcomes were favorable despite a lack of consistent follow-up.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis (Kao, Rabbani, Parkhurst, Mantravadi, Ting, Sim, Koehler, Shipchandler); Medical Student, Indiana University School of Medicine, Indianapolis (Patel). Corresponding Author: Taha Z. Shipchandler, MD, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, 1130 WMichigan St, Ste 400, Indianapolis, IN 46202 ( tshipcha@iupui.edu ).

LEVEL OF EVIDENCE 4 .

JAMA Facial Plast Surg . doi: 10.1001/jamafacial.2019.0312 Published online June 6, 2019.

© 2019 American Medical Association. All rights reserved.

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