PEDIATRIC FACIAL FRACTURES

In childhood, a generally impetuous nature and adventurous spirit combine to encourage participation in physical activities with little thought to immediate consequences, still paradoxically facial injuries in children are much less common than adults. Above all the immense capacity for healing in children within the shortest possible time with a minimum of complications, the assistance that growth can give, and the inherent ability to adapt to a new situation are quite different from what we see in adults. The pattern of Craniomaxillofacial fractures seen in children and adolescents varies with evolving skeletal anatomy and socioenvironmental factors. Mandibular fractures are the most common facial skeletal injury in pediatric trauma patients. Mandibular fractures in children most commonly occur in the condylar region, followed by parasymphysis and angle. The principles involved in the treatment of facial injuries are same irrespective of the age of the patient. However, the techniques in children are necessarily modified by certain anatomical, physiological and psychological factors. 

The general principles of treating mandibular fractures are the same in children and adults: Anatomic reduction is combined with stabilization adequate to maintain it until the bone union has occurred. Mandibular fractures in children tend to be minimally displaced and in a majority of cases can be treated conservatively. Significantly displaced mandibular fractures are reduced and immobilized using rigid internal fixation according to principles used in adults. Young bone possesses unique physical properties that coupled with space-occupying developing dentition give rise to patterns of fracture not seen in adults. Bone fragments in children may become partially united as early as four days and fractures become difficult to reduce by the seventh day. This results in a need for different forms of fixation as early as possible for the comparatively shorter duration of time. Nonunion or fibrous union rarely occurs in children and excellent remodeling occurs under the influence of masticatory stresses even when there is imperfect apposition of bone surfaces. The management of mandibular fractures in children differs somewhat from that of adults mainly because of concern for possible disruption of growth. The shape and shortness of deciduous crowns may make the placement of arch bars slightly more difficult in children. A child patient came to our hospital (Richardson’s dental & craniofacial hospital) with the fracture of parasymphysis region on it. side of the mandible and fracture of the condyle region on lt. side. Arch bars were placed and open reduction and internal fixation were done for parasymphysis fracture and later IMF elastics were placed for conservative treatment of condyle fracture.