Jaw fractures in children
- Donna Reyes Mendez, MD
Donna Reyes Mendez, MD
- Associate Professor of Emergency Medicine
- University of Texas Health Science Center (UTHSC) Medical School Houston
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Fractures of the facial bones and mandible are uncommon in children younger than five years of age; the incidence increases with increasing age and peaks between 16 and 20 years . One reason for this difference is that young children are relatively protected from the mechanical forces that lead to facial injury . As they age, they participate in activities that increase the risk of exposure to such forces (eg, falls from height, sports, bicycle riding, etc). In addition, certain features of the immature craniofacial skeleton render it relatively resistant to fracture.
This topic will discuss the evaluation and treatment of jaw fractures in children. Jaw fractures in adults and dental trauma in children are discussed separately. (See "Facial trauma in adults" and "Evaluation and management of dental injuries in children".)
DEVELOPMENTAL AND ANATOMIC CONSIDERATIONS
The force of impact during craniofacial trauma in young children is minimized by their small size and weight (and thus reduced inertia). In addition, the force of impact usually is absorbed by the forehead or skull rather than the face because the ratio of cranial to facial volume is greater in infants than in adults (8:1 versus 2:1) . Other features of the developing facial anatomy that account for the resistance to fracture include [2-7]:
- Relatively elastic facial bones compared with those of adults
- Poor pneumatization of the facial bones by the sinuses
- Relatively thick, short, elastic condyles compared with those of adults
- Thick adipose tissue surrounding the facial bones
- Stabilization of the maxilla and mandible by the unerupted teeth 
Fracture of the mandible occurs frequently among children with maxillofacial fractures. This was demonstrated in a retrospective series including 912 patients 18 years of age or younger in which 49 percent of maxillofacial fractures were of the mandible . The incidence of mandibular fractures is lowest in children younger than five years of age (1.2 per 100,000), and peaks between 16 and 20 years of age (26.5 per 100,000) .
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- DEVELOPMENTAL AND ANATOMIC CONSIDERATIONS
- ASSOCIATED INJURY
- Airway injury or obstruction
- Cervical spine
- Dentoalveolar fractures
- CLINICAL EVALUATION
- Condylar fractures
- Fractures of the body of the mandible
- Radiographic evaluation
- General considerations
- Unilateral condylar fractures
- Bilateral condylar fractures
- Fractures of the symphysis, body, and angle
- Condylar fractures
- - Ankylosis
- SUMMARY AND RECOMMENDATIONS