Resident Manual of Trauma to the Face, Head and Neck

Chapter 5: Mandibular Trauma

b. Panorex Panorex is difficult in the critically injured and uncooperative. It is the study of choice for mandible fractures. c. CT Scanning CT scanning provides a thin cut with three-dimensional and multiplanar reconstructions. It is especially useful for TMJ evaluation. d. Occlusal Views Occlusal views are used for evaluating symphyseal displacement. e. Periapical Radiographs Periapical radiographs are used for evaluating root and alveolar fractures. 2. Treating Pediatric Mandibular Fractures The general management principles for treating pediatric mandibular fractures are similar to those for adults, but differ because of the mixed dentition. Restoration of occlusion, function, and facial balance is required for successful treatment. The developmental growth of the child’s face must be taken into consideration. 74–77 Proper treatment may prevent complications, such as growth disturbance and infection. y y Younger than 2 years —Before age 2, a child’s jaws are often edentu- lous. Mandibular fracture would require an acrylic splint fixed with circummandibular wires. If immobilization of the jaw is necessary, the splint may be fixed to both occlusive surfaces, with both circumman- dibular wires and wires through the pyriform aperture. 78,79 y y 6–12 years —At ages 2–5 years, deciduous teeth are present and conical in shape (Figure 5.17). Interdental wiring may be used for fixation. Arch bars are difficult to secure below the gum line, and may require resin to attach wire for fixation. y y 6–12 years —In this age group, the mixed dentition, primary teeth are resorbing and often are loose. In, children 5–8 years, deciduous molars may be used for fixation, and in children 7–11 years, the primary molars and incisors may be used for fixation. When dentition is not available, splints may be used. y y 9–12 years —In this age group, MMF using arch bars is possible, because enough permanent dentition is present. Healing in children is rapid and often requires 10–20 days of immobili- zation. Delay in treatment may require callus removal for proper reduction. When ORIF is necessary the use of monocortical screws should be considered at the inferior mandibular border to prevent damage to developing permanent dentition. Resorbable polylactic and

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Resident Manual of Trauma to the Face, Head, and Neck