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Jaw fractures in children

Donna Reyes Mendez, MD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


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 [1]. One reason for this difference is that young children are relatively protected from the mechanical forces that lead to facial injury [2]. 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 "Initial evaluation and management of facial trauma in adults" and "Evaluation and management of dental injuries in children".)


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) [3]. 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

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Literature review current through: Nov 2017. | This topic last updated: Aug 11, 2016.
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  1. Azevedo AB, Trent RB, Ellis A. Population-based analysis of 10,766 hospitalizations for mandibular fractures in California, 1991 to 1993. J Trauma 1998; 45:1084.
  2. Thaller SR, Mabourakh S. Pediatric mandibular fractures. Ann Plast Surg 1991; 26:511.
  3. Maniglia AJ, Kline SN. Maxillofacial trauma in the pediatric age group. Otolaryngol Clin North Am 1983; 16:717.
  4. Krausen AS, Samuel M. Pediatric jaw fractures: indications for open reduction. Otolaryngol Head Neck Surg (1979) 1979; 87:318.
  5. Winzenburg SM, Imola MJ. Internal fixation in pediatric maxillofacial fractures. Facial Plast Surg 1998; 14:45.
  6. Tanaka N, Uchide N, Suzuki K, et al. Maxillofacial fractures in children. J Craniomaxillofac Surg 1993; 21:289.
  7. Rowe NL. Fractures of the jaws in children. J Oral Surg 1969; 27:497.
  8. Jamerson RE, White JA. Management of pediatric mandibular fractures. J La State Med Soc 1990; 142:11.
  9. Ferreira PC, Amarante JM, Silva PN, et al. Retrospective study of 1251 maxillofacial fractures in children and adolescents. Plast Reconstr Surg 2005; 115:1500.
  10. Oji C. Fractures of the facial skeleton in children: a survey of patients under the age of 11 years. J Craniomaxillofac Surg 1998; 26:322.
  11. Infante Cossio P, Espin Galvez F, Gutierrez Perez JL, et al. Mandibular fractures in children. A retrospective study of 99 fractures in 59 patients. Int J Oral Maxillofac Surg 1994; 23:329.
  12. Anderson PJ. Fractures of the facial skeleton in children. Injury 1995; 26:47.
  13. Thorén H, Iizuka T, Hallikainen D, Lindqvist C. Different patterns of mandibular fractures in children. An analysis of 220 fractures in 157 patients. J Craniomaxillofac Surg 1992; 20:292.
  14. Siegel MB, Wetmore RF, Potsic WP, et al. Mandibular fractures in the pediatric patient. Arch Otolaryngol Head Neck Surg 1991; 117:533.
  15. Morgan WC. Pediatric mandibular fractures. Oral Surg Oral Med Oral Pathol 1975; 40:320.
  16. Lee KH. Epidemiology of mandibular fractures in a tertiary trauma centre. Emerg Med J 2008; 25:565.
  17. Koltai PJ, Rabkin D. Management of facial trauma in children. Pediatr Clin North Am 1996; 43:1253.
  18. Bayles SW, Abramson PJ, McMahon SJ, Reichman OS. Mandibular fracture and associated cervical spine fracture, a rare and predictable injury. Protocol for cervical spine evaluation and review of 1382 cases. Arch Otolaryngol Head Neck Surg 1997; 123:1304.
  19. Andrew CT, Gallucci JG, Brown AS, Barot LR. Is routine cervical spine radiographic evaluation indicated in patients with mandibular fractures? Am Surg 1992; 58:369.
  20. Lee CY, McCullom C 3rd, Blaustein DI. Pediatric chin injury: occult condylar fractures of the mandible. Pediatr Emerg Care 1991; 7:160.
  21. Hubbard KA, Klein BL, Hernandez M, et al. Mandibular fractures in children with chin lacerations. Pediatr Emerg Care 1995; 11:83.
  22. Bertolami CN, Kaban LB. Chin trauma: a clue to associated mandibular and cervical spine injury. Oral Surg Oral Med Oral Pathol 1982; 53:122.
  23. McGrath CJ, Egbert MA, Tong DC, Myall RW. Unusual presentations of injuries associated with the mandibular condyle in children. Br J Oral Maxillofac Surg 1996; 34:311.
  24. Laws IM. Two unusual complications of fractured condyles. Br J Oral Surg 1967; 5:51.
  25. Posnick JC, Wells M, Pron GE. Pediatric facial fractures: evolving patterns of treatment. J Oral Maxillofac Surg 1993; 51:836.
  26. Avrahami E, Frishman E, Katz R. CT evaluation of otorrhagia associated with condylar fractures. Clin Radiol 1994; 49:877.
  27. Alcalá-Galiano A, Arribas-García IJ, Martín-Pérez MA, et al. Pediatric facial fractures: children are not just small adults. Radiographics 2008; 28:441.
  28. Spring PM, Cote DN. Pediatric maxillofacial fractures. J La State Med Soc 1996; 148:199.
  29. Waite DE. Pediatric fractures of jaw and facial bones. Pediatrics 1973; 51:551.
  30. Demianczuk AN, Verchere C, Phillips JH. The effect on facial growth of pediatric mandibular fractures. J Craniofac Surg 1999; 10:323.
  31. Myall RW, Sandor GK, Gregory CE. Are you overlooking fractures of the mandibular condyle? Pediatrics 1987; 79:639.
  32. Thorén H, Iizuka T, Hallikainen D, Lindqvist C. Radiologic changes of the temporomandibular joint after condylar fractures in childhood. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86:738.