From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center.
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health.
Plast Reconstr Surg. 2024 Sep 1;154(3):556e-568e. doi: 10.1097/PRS.0000000000010996. Epub 2023 Aug 15.
Mandibular fractures account for up to 48.8% of pediatric facial fractures; however, there are a wide range of available treatment modalities, and few studies describe trends in adverse outcomes of these injuries. This study describes fracture cause, pattern, management, and treatment outcomes in pediatric mandibular fracture patients.
A retrospective review was performed of patients younger than 18 years who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, cause, medical history, associated facial fractures, other associated injuries, treatments, and outcomes.
A total of 530 pediatric patients with 829 mandibular fractures were included in the analysis. Most isolated mandibular fractures were treated with physical therapy and rest ( n = 253 [47.7%]). Patients with combination fractures, specifically those involving the parasymphysis and angle, were 2.63 times more likely to undergo surgical management compared with patients with a single facial fracture ( P < 0.0001). Older age ( P < 0.001), sex ( P = 0.042), mechanism ( P = 0.008) and cause of injury ( P = 0.002), and specific fractures (eg, isolated angle [ P = 0.001]) were more associated with adverse outcomes. The odds of adverse outcomes were higher for patients treated with closed reduction and external fixation or open reduction and internal fixation compared with conservative management (OR, 1.8, 95% CI, 1.0 to 3.2; and OR, 2.1, 95% CI, 1.2 to 3.5, respectively).
Fracture type, mechanism of injury, and treatment modality in pediatric mandibular fractures are associated with distinct rates and types of adverse outcomes. Large-scale studies characterizing these injuries are critical for guiding physicians in the management of these patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
下颌骨骨折占儿童面部骨折的 48.8%；然而，有多种治疗方法可供选择，很少有研究描述这些损伤不良后果的趋势。本研究描述了儿科下颌骨骨折患者的骨折原因、类型、治疗方法和治疗结果。
对 2006 年至 2021 年在一家儿科一级创伤中心接受下颌骨骨折评估的 18 岁以下患者进行了回顾性研究。研究的变量包括人口统计学、病因、病史、相关面部骨折、其他相关损伤、治疗方法和结果。
共纳入 530 例儿童患者，829 例下颌骨骨折，纳入分析。大多数孤立性下颌骨骨折采用物理治疗和休息（n=253[47.7%]）治疗。与单一面部骨折患者相比，联合骨折，特别是涉及正中联合和下颌角的骨折，接受手术治疗的可能性高 2.63 倍（P<0.0001）。年龄较大（P<0.001）、性别（P=0.042）、机制（P=0.008）和损伤原因（P=0.002）以及特定骨折（例如，孤立性下颌角骨折，P=0.001）与不良结局更相关。与保守治疗相比，接受闭合复位和外固定或切开复位和内固定治疗的患者发生不良结局的可能性更高（OR，1.8，95%CI，1.0 至 3.2；OR，2.1，95%CI，1.2 至 3.5）。
儿童下颌骨骨折的骨折类型、损伤机制和治疗方式与不同的不良结局发生率和类型相关。对这些损伤进行大规模研究对于指导医生治疗这些患者至关重要。
临床问题/证据水平：风险，III。
