Pediatric Mandible Fractures: Mechanism, Pattern of Injury, Fracture Characteristics, and Management by Age.

Background

Development of the craniofacial skeleton and different mechanisms of injury warrant different treatment paradigms for younger children versus those at skeletal maturity.

Objective

To characterize the mechanism, fracture patterns, and management of mandible fractures across the pediatric age spectrum.

Methods

A 10-year retrospective review of <18-year-old children with mandible fractures at a level 1 trauma center. Characteristics were compared by age subgroup analysis.

Results

Of 220 patients meeting inclusion criteria, motor vehicle collision (n = 53, 40.8%), falls (n = 48, 36.9%), and assault (n = 19, 14.6%) were the most common mechanisms with more falls in younger children and more injury by assault in teenagers. Condylar fractures were most common in the 0- to <9-year-old children (n = 27, 38.4%); angle/ramus fractures (56, 62.6%) were most common in 15- to <18-year-old children (p < 0.001). Nonsurgical management was associated with younger age (p < 0.001). Fourteen of 125 patients (8.0%) undergoing surgical intervention experienced complications. Being uninsured was associated with shorter median (interquartile range) follow-up of 5.6 (1.4-10.7) weeks, compared with private [11.9 (4.3-49.0) weeks] and public insurance [11.7 (3.7-218.0) weeks] (p < 0.001).

Conclusion

The mechanism, fracture sites, and treatment differed by age with the youngest frequently managed nonoperatively and teenagers treated with adult algorithms. Complications were rare overall within 6-12 weeks after injury, with or without surgical management.