HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Original Investigation Research

Management of Mandible Fracture in Children

occurs more rapidly in children, close follow-up is critical to ensuring that any deformity or concerns may be addressed in a timely fashion. Limitations There were several limitations with our study. Given the ret- rospective nature of the study, we were able to assess out- comes only through follow-up visits documented in the elec- tronic medical record. Medical documentation itself has its practitioner-specific deficiencies andmay not adequately rec- ord specific symptoms thatmaybe related to themandible frac- ture repair. Given the poor follow-up, we were unable to as- sess the true complication rate for all 150 patients. It would be ideal to study these patients in a prospective fashion and fol- low them in present time to analyze the outcomes of our op- erations. Conclusions Conservativemanagement is favored for most pediatricman- dible fractures. In operative cases, maxillomandibular fixa- tion is most commonly used. This approach seeks to de- crease the degree ofmandibular growth restriction by limiting periosteal dissection, physical strain on the developing bone, and injury to the bone itself. This approach uses the greater osteogenic potential inherent to thepediatric population. Open reduction internal fixationwith use of titaniumplateswas less commonly used compared with absorbable plating. Further studies may be necessary to assess the outcomes of pediatric mandible fracture repair with longer follow-up.

may be necessary to determine the safety and efficacy of re- sorbable plating in pediatric mandible fractures. In our study, the documented complication rate was low (13 of 150 patients [8.7%]), and this is likely owing in part to the relatively low follow-up rate (60 patients [40.0%]). Our complications, which includedmalunion andnonunion, hard- ware extrusion, and infection, were largely correctable and therewere no documented cases of postoperative facial weak- ness. Because this study took place at a tertiary care aca- demic referral center in an urban setting, the likelihood of follow-up may be intrinsically decreased for portions of the patient population. Factors that affect likelihood of follow- up, which are complex and beyond the scope of this paper, include socioeconomic status, insurance type, ease of public transportation, and proximity to the practice. We found that children 6 years or younger were statisti- cally more likely to be observed, and children older than 12 yearsweremore likely to receive internal fixation of theirman- dible fractures. Much of this may be attributed to the de- creased severity of mandible fractures seen in young chil- dren, who have an inherentlymore resilient facial skeleton for reasons discussedpreviously. Incontrast,weobserve that older children who receive plating are likely to keep their hardware without any reports of growth restriction. In the absence of other known complications, this management for mandible fractures is often appropriate given that older children espe- cially in their teenage years will have grown into their adult facial skeleton. Therefore, surgeons should counsel patients and their families that deformity as a product of growth restriction due to plating is a concern, but it may be less applicable in the older,more-developed child. Because healing

Conflict of Interest Disclosures: None reported.

ARTICLE INFORMATION Accepted for Publication: March 23, 2019.

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Published Online: June 6, 2019. doi: 10.1001/jamafacial.2019.0312

Author Contributions: Dr Shipchandler had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Kao, Mantravadi, Ting, Sim, Shipchandler. Acquisition, analysis, or interpretation of data: Kao, Rabbani, Patel, Parkhurst, Mantravadi, Koehler, Shipchandler. Drafting of the manuscript: Kao, Patel, Koehler. Critical revision of the manuscript for important intellectual content: Kao, Rabbani, Parkhurst, Mantravadi, Ting, Sim, Shipchandler. Statistical analysis: Parkhurst, Shipchandler. Administrative, technical, or material support: Rabbani, Mantravadi, Ting. Supervision: Kao, Rabbani, Mantravadi, Ting, Sim, Koehler, Shipchandler.

(Reprinted) JAMA Facial Plastic Surgery Published online June 6, 2019

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