This case report describes the treatment of a 11-year old boy who suffered multiple facial fractures including fractures of the mandibular body and condyle, avulsion of a maxillary lateral incisor, and a horizontal root fracture of a maxillary central incisor from an automobile accident. Initial examination revealed abrasions, lacerations, limited mouth opening, and deviation upon opening. CBCT imaging showed fractures of the mandibular body, condyle, and lingual side. Treatment included closed reduction techniques, a vacuum formed splint, brackets on posterior teeth, analgesics, antibiotics, and endodontic therapy. Follow up at 18 months and 6 years showed healing of the fractures with normal jaw function and movement restored.

1. Facial
fractures
Case Report
A Complex Facial Trauma Case with Multiple Mandibular
Fractures and Dentoalveolar Injuries

2. Introduction
The purpose of this case report is to present the clinical and radiographic
evaluation and management of a child who suffered a facial trauma resulting in
fractures of the mandibular body and condyle, tooth avulsion, and horizontal root
fracture, followed up with the result of treatment.
Less than 15% of all facial fractures take place in pediatric age groups and these
occur very rarely (1%) in children under 5 years of age.

3. A healthy 11-year-old boy was referred to the clinics of
Department of Pediatric Dentistry, following a severe facial
trauma as a result of automobile accident.
Initial physical examination showed
• Abrasions
• Lacerations
• Limited opening of the mouth
• lateral deviation
Intraoral examination revealed
• Missing tooth
• Uncomplicated crown fracture
• Subluxation

4. CBCT examination revealed
• Nondisplaced mandibular Body fracture
• Greenstick fracture on the left lingual side
• Subcondylar fracture

5. Radiograph shows
• Avulsion of the maxillary left lateral incisor
• Horizontal root fracture of the maxillary right central incisor

6. Management
• Closed reduction techniques
• Vacuum formed splint was
fitted in the lower arch
• Brackets were attached to
the maxillary posterior teeth
• Analgesics and antibiotics
were prescribed
• Chlorhexidine mouthwash
• Endodontic therapy was
performed

7. Clinical and radiological examination after 18 months revealed
• Uneventful healing with reduction of the condylar
head and remodeling of the condylar process
• Complete healing of the mandibular body fractures
After 6 years
• Discoloration on his maxillary right central incisor
• The mandible showed no deviation during mouth
opening and closing movements.

8. Conclusion
In the present case report, conservative treatment child showed satisfactory
functional outcomes at a 6-year follow-up. An appropriate splint guided the
correct remodeling of the condyles and allowed restoration of the normal shape
and height of the fractured process.
Although nonsurgical management should be considered as primary preferred
method in children with mandibular fractures, each case should be evaluated
individually.

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