Resident Manual of Trauma to the Face, Head and Neck

Chapter 5: Mandibular Trauma

4. Treating Pediatric Body and Angle Fractures y y Greenstick fractures are managed with soft diet and pain control. y y Minimal to moderate displacement is treated with MMF with or without elastics. y y Angle fractures cannot be treated with dental splints. y y An extraoral open reduction approach may be indicated for severe displacement. 5. Treating Pediatric Dentoalveolar Fractures Dentoalveolar injuries range from 8 percent to 50 percent of pediatric mandibular fractures. a. Primary Teeth Replacement of primary teeth is unnecessary. Primary teeth act as space holders for the permanent dentition. Space-holding appliances may be needed after the premature loss of primary teeth in trauma. b. Permanent Teeth y y Permanent teeth should be reinserted within 2 hours. The teeth may be transported in saline or milk. y y Single or multiple teeth may be fixated with wire-acid etch composite splinting using stainless steel wire. Care should be take to avoid the gingiva and the opposing teeth (Figure 5.12). y y The fractured segment may be reduced, and the patient is placed in MMF. y y Large fractured segments may require plate-screw fixation, if this is possible without injuring the teeth. VIII. References 1. Peltier J, Ryan MW. Mandible fractures. Grand Rounds Presentation. Galveston, Texas: University of Texas Medical Branch, Department of Otolaryngology; May 26, 2004. Accessed at: http:// www.utmb.edu/otoref/grnds/Mandible-fx-040526/ Mandible-fx-040526.htm. 2. Barton JR. A systemic bandage for fractures of the lower jaw. Am Med Recorder Phila. 1819;2:153. 3. Gunning TB. Treatment of fracture of the lower jaw by interdental splints, I. Amer J Dent Sci. 1868;2:53-55. 4. Gilmer TL. A case of fracture of the lower jaw with remarks on treatment. Arch Dent. 1887;43(4):388.

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