Open Reduction and Internal Fixation in Pediatric Mandibular Fractures

thick surrounding adipose tissue, and stabilization of the mandible and maxilla by the unerupted teeth.2 Pediatric mandible fractures are uncommon and have been treated by a wide variety of fixation methods. Incomplete or nondisplaced fractures as well as fractures of the subcondylar region are treated by traditional methods of a soft diet or closed reduction. Displaced fractures are better served by open reduction and internal fixation (ORIF). Excluding the nasal bones, the mandible is the most frequently fractured facial bone in pediatric patients. Onethird of pediatric trauma patients with facial fractures have mandibular fracture. The treatment of pediatric mandibular fractures is controversial and complicated by many factors such as tooth eruption, short roots, developing tooth buds, and growth especially at the mixed dentition stage. Rigid fixation is a technique used in the management of facial fractures that has been developed for more than 20 years.3 However, use in children is somewhat controversial. Many studies on infant animals showed that plate fixation across the mid-facial and cranial sutures lines have resulted in growth retardation along these suture lines. Since these studies were performed on infant animals with rapid facial growth patterns, it was difficult to draw firm conclusions with regard to human children.4 But these studies did highlight the fact that rigid fixation should be used cautiously in children. If proper reduction of facial fractures is not achievable by other means, rigid fixation should be performed because the alternative of improper correction is unacceptable. The goals of treatment should be an accurate reduction, three-dimensional restorations of preinjury form and functions.5 If it requires rigid fixation with plating, then this must be done using monocortical screws at the inferior border of the mandible to avoid damaging the underlying teeth. The commonly used osteosynthesis technique for the fixation of adult parasymphysial fractures is to use two miniplates: One at the inferior border of the mandible and the other above it as a tension band to withstand the torsion forces in this area of the mandible.6 Many factors make closed reduction difficult in pediatric mandibular fractures. The child is more difficult 1,3Reader, 2Senior Lecturer, 4Principal 1-4Department of Oral and Maxillofacial Surgery, Kannur Dental College, Anjarakandy, Kerala, India