Causes and Treatment of Mandibular and Condylar Fractures in Children and Adolescents A Review of 104 Cases

IMPORTANCE There are no uniform treatments, standards, and specifications for conservative and surgical management of mandibular fractures in children and adolescents. OBJECTIVE To review the management of mandibular fractures in children and adolescents at our institution. DESIGN, SETTING, AND PARTICIPANTS The medical records of 104 children and adolescents (60 male and 44 female) treated for mandibular fractures from 2005 to 2012 at the Ninth People's Hospital, Shanghai, China, were retrospectively reviewed. The participants were classified as having deciduous dentition (age <= 6 years), mixed dentition (age > 6 but < 12 years), and permanent dentition (age >= 12 but <= 16 years). INTERVENTIONS Conservative treatment and surgical management. MAIN OUTCOMES AND MEASURES Helkimo clinical dysfunction and anamnestic indices. RESULTS Condylar process fractures accounted for 55.7% of the fractures (112 fractures of 201 total fracture sites), and symphysis fractures, parasymphysis fractures, fractures of the body, and fractures of the angle accounted for 20.9%, 11.9%, 7.0%, and 3.5% of the fractures, respectively. A total of 83 cases with 159 fracture sites with complete follow-up data were included in the treatment analysis. In these 83 patients, 77 fractures were dentigerous bone fractures, 46 were intracapsular fractures, and 36 were extracapsular fractures. Dentigerous bone fractures of the mandible were managed by closed or open reduction in children younger than 12 years and were managed more often by open reduction and fixation in those between ages 12 and 16 years. Closed treatment was performed for 22 condylar process fractures (28.6%), and open reduction was carried out for 55 condylar process fractures (71.4%). In patients with intracapsular fractures, there was no significant relationship between dentation age and treatment method (P =.06). Most patients with extracapsular fractures with permanent dentition underwent surgical fixation (73.3%), whereas most with deciduous dentition received conservative treatment (87.5%). In patients with condylar process fractures, there was no significant difference in Ai and Di based on treatment method (P =.49 and P =.76, respectively). CONCLUSIONS AND RELEVANCE The treatment of mandibular fractures in children and adolescents should be determined by clinical factors including age, location, and type of fracture.