This document discusses the treatment of a 6-year-old male patient who presented with disocclusion of teeth and a deformed mandible for 15 days following a road traffic accident. Diagnostic studies including CBCT were performed. A treatment plan was developed to fabricate a cap splint using alginate impressions and stone casts. The splint was used for audiovisual distraction and tying of an arch bar for realignment and stabilization of the mandible during healing. Conservative treatment is emphasized for pediatric mandibular fractures to allow for facial growth and development.

1. 1
Dr. Manoranjan Mahakur
1st year MDS
Department of Pedodontics & Preventive Dentistry,
SCB Dental College & Hospital,Cuttack -7, Odisha

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….
A- January
C- April
B-March
D- August

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 6 year old male
patient.
 Complains of dis-
occlusion of teeth ,
with deformed
mandible since 15
days

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 RTA on dated 1/12/2017
 Admitted to SCBMC causality.
 Treated at Orthopaedics
department for fracture right
femur
PAST MEDICAL AND FAMILY HISTORY

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General-
 Non ambulatory, conscious
 I0,Po,Cyo,Clo
 Vital signs:
BP- ??? mm of Hg
Pulse- 100 bpm
Respiratory rate- 20/min
Temperature- 98.6⁰F

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FEATURES EXTRA-ORAL INTRA ORAL
LOCATION, SHAPE,
SIZE, MARGIN
Step deformity on right
side of mandible wrt 83
region.
•Disocclusion of arch
Slightly mobility of
mandibular segment
• Limited mouth opening
• Rt side parasymphyseal
area ulceration
TENDERNESS Present Present
PUS DISCHARGE Absent Absent
LYMPH NODES Not-palpable Not palpable

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Teeth present
55,54,53,52.51,61,62,63,63,65
75,74,73,72,71,81,82,83,84,85

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 CBCT

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TREATMENT PLANNING

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Fabrication of Cap Splint
s
LA
Upper and lower alginate
impression
Stone cast / check for dis
occlusion
Re-fracture and rejoining of cast
in occlusion
A cap splint with clear acrylic was
fabricated on mandibular cast

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REFRACTURE & ALINGED CAST

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CAP SPLINT MADE

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AUDIO VISUAL DISTRACTION

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TYING OF ARCH BAR

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 Children are not simply “small adult”
 Active facial growth and dental development

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 Facial # low in children
 Protective social environment
In children due to low centre of gravity less injuries
occurs during fall down
Males affected twice as frequently as females
Most common cause motor cycle accident (55.1%)
Assaulted (14.55)
Fall 8.6%

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Muscle Attachment To Mandible
A Overview

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Muscle Attachment To Mandible
A Overview

27. DIAGNOSTIC STUDIES
 OPG
 LATERAL OBLIQUE
 PA
 TOWNES VIEW
 CT (Gold Standard)
27

28.  During infancy and early childhood-mid face and orbit
are more prone to #
(i)Prominent forehead and orbit
(ii)Rapid brain growth (90% of adult in 3-5 yrs)
(iii) Skeletal maturity of orbit
 Bone high osteogenic potential (Thick medullary and
thin cortical) = more greenstick #
 Short bulbous crown of primary teeth and permanent
bud makes difficult for MMF
28

29. PATHOLOGIC ANATOMY
later childhood
 Lower 2/3 of face becomes more prominet for #
Bcoz forward and downward growth of face
 Mandibular body is lengthen …
 Deposition of bone at the posterior ramus
 Resorption of bone at anterior ramus.
(functional matrix theory)
 Mandible is the last bone in face to reach skeletal
maturity ( more prone for #)
29

30. TREATMENT /
RECONSTRUCTION GOAL
 Return to Pre-injury function and appearance
 Maintain facial symmetry and occlusion
 Maintaining subsequent facial growth and dental
development
 Minimize morbidity and shortening the course of
treatment
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31. INFANT MANDIBULAR #= Observation only
31

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CLOSED
CAP
SPLINT
OPEN
MMF
miniplate

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 MMF
 Circum-mandibular wiring
 Monomaxillary fixation with cap splint
 Open reduction with monocortical plate
 Champy Technique avoided

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Shortening of the ramus on affected test
Deviation of chin to affected side
Open bite on unaffected side
Flattening of the body of the mandible
unaffected side
In bilateral #,Posterior displacement of the
mandible

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Major concern
(i) Significant number of these injury never
diagnosed
(ii) Cause significant lower facial asymmetry
and masticatory dysfunction.
More prone site Condylar head (adult- in neck)

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 In children open reduction is not frequently
indicated .
 Rapid and progressive modelling of condyle
 Very brief period of MMF (7-14 days) followed by
physiotherapy and training elastic
 Long term follow-up
 Some times growth modification may be needed by
appliance
 Maintenance of mandibular projection ,symmetry,
and functional occlusion

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 Pediatric dentists before going ahead with
any kind of surgical intervention for the
treatment of paediatric mandibular
fractures, utmost priority should be given
for a conservative treatment plan keeping
in mind the anatomical complexity of the
developing mandible.

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“I will respect the privacy of my patients, for their
problems are not disclosed to me that the world may
know”.
( Hippocratic oath line 5 )