Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Association for Cranio Maxillo Facial Surgery (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

The most preferred method of management of displaced pediatric mandibular fracture: a systematic review and meta-analysis

  • Satnam Singh Jolly (Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education and Research) ;
  • Kamaljit Kaur (Department of Pediatric and Preventive Dentistry, Bhojia Dental College) ;
  • Vidya Rattan (Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education and Research) ;
  • Apoorva Singh (Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education and Research) ;
  • Tanvi Kiran (Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research)
  • Received : 2025.03.25
  • Accepted : 2025.04.09
  • Published : 2025.04.20
Download PDF
⟨ Previous Next ⟩

Abstract

Background: There are diverse treatment modalities available for managing pediatric dentate mandibular fractures, ranging from various closed reduction techniques to open reduction methods. This systematic review and meta-analysis aim to evaluate the most appropriate and preferred management method for pediatric dentate mandibular fractures, focusing on outcomes such as wound infection and malocclusion. Methods: A systematic search was performed using the PubMed Central and Scopus databases from January 1980 to December 2022, following PRISMA guidelines. The inclusion criteria comprised case reports with more than 10 cases, clinical trials, and prospective and retrospective clinical studies addressing the management of displaced dentate-segment mandibular fractures in patients up to 15 years old using open and/or closed reduction techniques. Results: Six retrospective studies were included in the systematic review and meta-analysis. The primary outcomes assessed were wound infection and malocclusion. The pooled estimate for wound infection significantly favored the maxillomandibular fixation (MMF) group (p= 0.0007). In contrast, although the pooled estimate for malocclusion favored surgical treatment, the difference was not statistically significant (p= 0.86). Conclusion: The risk of wound infection is significantly lower with MMF in pediatric mandibular fractures, while open reduction and internal fixation (ORIF) using miniplates is associated with a relatively lower risk of malocclusion, although this difference is not statistically significant. The authors conclude that, based on reduced wound infection rates, MMF should be the preferred management approach, whereas ORIF should be reserved for severely displaced and comminuted fractures. Future randomized controlled trials with larger sample sizes are needed to validate and strengthen these findings.

Keywords

Acknowledgement

This article is dedicated to the Late Prof. Sachin Rai for his contribution and guidance to the department.

References

  1. Posnick JC, Wells M, Pron GE. Pediatric facial fractures: evolving patterns of treatment. J Oral Maxillofac Surg 1993;51:836-45. https://doi.org/10.1016/S0278-2391(10)80098-9
  2. Wainwright DJ, Moffitt JK, Bartz-Kurycki M, Wainwright DJ, Anderson K, Demian N, et al. The trends of pediatric facial fractures due to violence in a level one trauma population. J Craniofac Surg 2019;30:1970-3. https://doi.org/10.1097/SCS.0000000000005613
  3. Zhang B, Liu ZH, Li J, Zhang K, Chen JJ, Zhang RM. Open reduction and internal fixation of severely dislocated fractures of condylar neck and base using bioabsorbable miniplate in children: a 3-10 years follow-up study. Int J Pediatr Otorhinolaryngol 2014;78:1987-92. https://doi.org/10.1016/j.ijporl.2014.09.004
  4. Moffitt JK, Wainwright DJ, Bartz-Kurycki M, Wainwright DJ, Demian N, Teichgraeber JF, et al. Factors associated with surgical management for pediatric facial fractures at a level one trauma center. J Craniofac Surg 2019;30:854-9. https://doi.org/10.1097/SCS.0000000000005245
  5. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71
  6. Sedgwick P. Meta-analyses: how to read a funnel plot. BMJ 2013;1:346:f1342. https://doi.org/10.1136/bmj.f1342
  7. Yesantharao PS, Lopez J, Reategui A, Jenny H, Najjar O, Yu JW, et al. Combined symphyseal and condylar fractures: considerations for treatment in growing pediatric patients. Plast Reconstr Surg 2021;148:51e-62e. https://doi.org/10.1097/PRS.0000000000008055
  8. Yesantharao PS, Lopez J, Reategui A, Najjar O, Yu JW, Pourtaheri N, et al. Open reduction, internal fixation of isolated mandible angle fractures in growing children. J Craniofac Surg 2020;31:1946-50. https://doi.org/10.1097/SCS.0000000000006892
  9. Yesantharao PS, Lopez J, Reategui A, Najjar O, Redett RJ, Manson PN, et al. Managing isolated symphyseal and parasymphyseal fractures in pediatric patients. J Craniofac Surg 2020;31:1291-6. https://doi.org/10.1097/SCS.0000000000006573
  10. Karim T, Khan AH, Ahmed SS. Trauma of facial skeleton in children: an Indian perspective. Indian J Surg 2010;72:232-5. https://doi.org/10.1007/s12262-010-0056-x
  11. Kambalimath HV, Agarwal SM, Kambalimath DH, Singh M, Jain N, Michael P. Maxillofacial injuries in children: a 10 year retrospective study. J Maxillofac Oral Surg 2013;12:140-4. https://doi.org/10.1007/s12663-012-0402-6
  12. Eskitascioglu T, Ozyazgan I, Coruh A, Gunay GK, Yuksel E. Retrospective analysis of two hundred thirty-five pediatric mandibular fracture cases. Ann Plast Surg 2009;63:522-30. https://doi.org/10.1097/SAP.0b013e318194fdab
  13. Goplen CM, Verbeek W, Kang SH, Jones CA, Voaklander DC, Churchill TA, et al. Preoperative opioid use is associated with worse patient outcomes after total joint arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019;20:234. https://doi.org/10.1186/s12891-019-2619-8
  14. Hajibandeh J, Peacock ZS. Pediatric mandible fractures. Oral Maxillofac Surg Clin North Am 2023;35:555-62. https://doi.org/10.1016/j.coms.2023.05.001
  15. Bhola N, Jadhav A, Borle R, Khemka G, Adwani N, Bhattad M. Lateral compression open cap splint with circummandibular wiring for management of pediatric mandibular fractures: a retrospective audit of 10 cases. Oral Maxillofac Surg 2014;18:65-8. https://doi.org/10.1007/s10006-013-0391-8
  16. Bansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS. Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study. J Craniomaxillofac Surg 2021;49:196-205. https://doi.org/10.1016/j.jcms.2020.12.013
  17. Ongodia D, Li Z, Xing WZ, Li ZB. Resorbable plates for fixation of complicated mandibular fractures in children. J Maxillofac Oral Surg 2014;13:99-103. https://doi.org/10.1007/s12663-013-0501-z
  18. Kostares E, Kostare G, Kostares M, Kantzanou M. Prevalence of surgical site infections after open reduction and internal fixation for mandibular fractures: a systematic review and metaanalysis. Sci Rep 2023;13:11174. https://doi.org/10.1038/s41598-023-37652-6
  19. Andreasen JO, Storgård Jensen S, Kofod T, Schwartz O, Hillerup S. Open or closed repositioning of mandibular fractures: is there a difference in healing outcome? A systematic review. Dent Traumatol 2008;24:17-21. https://doi.org/10.1111/j.1600-9657.2006.00498.x
  20. Moreno JC, Fernandez A, Ortiz JA, Montalvo JJ. Complication rates associated with different treatments for mandibular fractures. J Oral Maxillofac Surg 2000;58:273-81. https://doi.org/10.1016/S0278-2391(00)90051-X
  21. Ellis E 3rd, Muniz O, Anand K. Treatment considerations for comminuted mandibular fractures. J Oral Maxillofac Surg 2003;61:861-70. https://doi.org/10.1016/S0278-2391(03)00249-0
  22. Shetty V, Atchison K, Leathers R, Black E, Zigler C, Belin TR. Do the benefits of rigid internal fixation of mandible fractures justify the added costs? Results from a randomized controlled trial. J Oral Maxillofac Surg 2008;66:2203-12. https://doi.org/10.1016/j.joms.2008.06.058