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混合牙列期小儿下颌骨骨折与牙外伤的治疗方式:系列病例研究

Management Modalities of Mandible Fracture and Dental Trauma in Pediatric Patients During Mixed Dentition Phase: A Series of Case Study.

作者信息

Ronrang Lomtu, Lyngdoh Alice

机构信息

Department of Dentistry, NEIGRIHMS (North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences), Shillong, India.

出版信息

Case Rep Dent. 2025 Jan 2;2025:6662463. doi: 10.1155/crid/6662463. eCollection 2025.

Abstract

The prevalence of oromaxillofacial fracture in pediatric patients is comparatively less than in adults, which could be due to several inconclusive factors, such as infrequent exposure to high-contact sports games, rash driving of vehicles and motorbikes, alcohol consumption, and fist fights for personal reasons under the influence of alcohol. More importantly, most of the time, children are under the care of their parents till they reach an age of maturity. One more thing that everyone believes even today is the elasticity nature of their bones as well as their body weight during their growing stage. All these uncertain factors, including the natural way of protection bestowed on us by nature during the childhood stage, might be the actual factors that can easily resist any form of minor trauma in pediatric patients. But sometimes, we come across children who have suffered traumatic head and neck injuries, including mandible fractures, usually falling from a height, and road site accidents while playing on the roadsides, including traffic accidents, which are inevitable. This is a case of three pediatric patients who had experienced accidental dental trauma with slight-displaced mandible fractures with slight dearrangement of normal occlusion and avulsion of permanent teeth. The cases were managed individually according to the types of trauma and injury they had sustained. Among three cases, one was a 9-year-old female pediatric patient, and the other two were male pediatric patients of 7 years old. Clinically, female patients had no mandible fracture as such except avulsion of teeth in the region of 32, 33, and 34. Both the male patients had a slight displacement of the mandible with a dearrangement of occlusion, and one male patient had a bilateral mandible fracture. So considering the nature and type of an injury they had sustained individually, different treatment modalities were employed for each individual as per their requirement for the restoration of normal occlusion, including hard and soft tissues. The prime objectives were the restoration of normal occlusion and alignment of the jawbone, including esthetic and phonetic, without impairing normal growth and development of jawbone and permanent tooth buds. The purpose of this article is to emphasize noninvasive methods of pediatric mandibular fracture reduction, restoration of normal occlusion, and management of soft tissue. Our treatment modalities show that this method can be easily applied in cases of any slightly displaced mandibular fracture in children during mixed dentition periods while taking utmost care of permanent tooth buds compared to other invasive methods of pediatric mandibular fracture management. The application of these various noninvasive treatment modalities and their clinical application for the management of slight displacement of mandibular fractures in pediatric cases were effective and clinically apparent in our study. The study also shows that various treatment modalities employed for the management were acceptable in terms of patient compliance due to noninvasive methods of management for slightly undisplaced mandibular fractures in pediatric cases.

摘要

小儿颌面部骨折的患病率相对低于成人,这可能是由于几个尚无定论的因素,如较少参与高接触性体育比赛、鲁莽驾驶车辆和摩托车、饮酒以及在酒精影响下因个人原因打架斗殴。更重要的是,大多数时候,儿童在成年之前都受到父母的照顾。时至今日,大家还认为的另一个因素是儿童在生长阶段骨骼的弹性以及他们的体重。所有这些不确定因素,包括童年时期大自然赋予我们的自然保护方式,可能是小儿患者能够轻易抵御任何形式轻微创伤的实际因素。但有时,我们会遇到遭受头颈部创伤的儿童,包括下颌骨骨折,通常是从高处跌落,以及在路边玩耍时发生的道路事故,包括交通事故,这些都是不可避免的。这是一例三名小儿患者的病例,他们均经历了意外牙外伤,伴有下颌骨轻微移位骨折、正常咬合轻度紊乱以及恒牙脱落。根据他们所遭受的创伤类型对病例进行了个体化处理。在这三个病例中,一名是9岁的女性小儿患者,另外两名是7岁的男性小儿患者。临床上,女性患者除了32、33和34区域的牙齿脱落外,没有下颌骨骨折。两名男性患者均有下颌骨轻微移位伴咬合紊乱,其中一名男性患者双侧下颌骨骨折。因此,考虑到他们各自所遭受损伤的性质和类型,根据恢复正常咬合(包括硬组织和软组织)的需求,对每个人采用了不同的治疗方式。主要目标是恢复正常咬合和颌骨排列,包括美观和发音方面,同时不损害颌骨和恒牙胚的正常生长发育。本文的目的是强调小儿下颌骨骨折复位、恢复正常咬合以及软组织处理的非侵入性方法。我们的治疗方式表明,与小儿下颌骨骨折管理的其他侵入性方法相比,这种方法在混合牙列期儿童任何轻微移位的下颌骨骨折病例中都可以轻松应用,同时要 utmost care of permanent tooth buds(此处原文有误,可能是“take utmost care of permanent tooth buds”,即“ utmost care of permanent tooth buds”应改为“take utmost care of permanent tooth buds”,意思是“ utmost care of permanent tooth buds”应改为“take utmost care of permanent tooth buds”,即“对恒牙胚给予最大程度的保护”)。在我们的研究中,这些各种非侵入性治疗方式及其在小儿下颌骨骨折轻微移位管理中的临床应用是有效的且在临床上是明显的。该研究还表明,由于小儿下颌骨骨折轻微移位采用非侵入性管理方法,所以所采用的各种治疗方式在患者依从性方面是可以接受的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6576/11717442/922add0562e9/CRID2025-6662463.001.jpg

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