Pediatr Emerg Care. 2023 Dec 1;39(12):923-928. doi: 10.1097/PEC.0000000000002906. Epub 2023 Jan 14.
Mandible fractures are uncommon injuries in infants and young children and may raise concern for nonaccidental trauma. Our study describes several children with mandible fractures to identify features that might differentiate abuse from accident.
Records and imaging were reviewed for children aged 24 months and younger who were diagnosed with mandible fractures at 2 tertiary pediatric care centers. Twenty-one cases were included, 8 of whom had formal child abuse consultations. Cases were reviewed for mechanisms of injury, physical examination findings, and occult injuries identified, as well as the final abuse determination.
Among children with child abuse consultations, 5 injuries (62.5%) were determined to be accidental, 1 (12.5%) was abusive, and 2 were indeterminate for abuse or accident (25%). In each accidentally injured child, the reported mechanism of injury was a short fall with evidence of facial impact. No accidentally injured child had unexpected occult injuries or noncraniofacial cutaneous injuries.
Infants and young children can sometimes sustain mandible fractures accidentally after well-described short falls with evidence of facial impact. Abuse remains in the differential diagnosis, and children should be evaluated accordingly. We propose that accidental injury be considered when a well-evaluated child with an isolated mandible fracture has a history of a short fall.
下颌骨骨折在婴幼儿中较为少见，可能会引起人们对非外伤性损伤的关注。本研究描述了几例下颌骨骨折的患儿，以确定可能有助于将虐待与意外区分开来的特征。
对在 2 家三级儿科护理中心被诊断为下颌骨骨折的 24 个月及以下儿童的病历和影像学资料进行了回顾。共纳入 21 例病例，其中 8 例接受了正式的儿童虐待咨询。对损伤机制、体格检查结果和隐匿性损伤的发现，以及最终的虐待诊断进行了回顾。
在接受儿童虐待咨询的病例中，有 5 例（62.5%）被确定为意外伤，1 例（12.5%）为虐待伤，2 例（25%）为虐待或意外伤不确定。每个意外受伤的患儿均有明确的短距离跌落病史，且有面部撞击的证据。没有意外受伤的患儿有隐匿性或非头面部皮肤损伤。
有时，有明确的短距离跌落病史且有面部撞击证据的婴幼儿可发生下颌骨骨折意外伤。虐待仍需纳入鉴别诊断，应相应地对患儿进行评估。我们建议，当经过充分评估的、有孤立性下颌骨骨折且有短距离跌落病史的患儿存在隐匿性损伤时，应考虑意外伤的可能性。
