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Background/aim: Mandibular fractures are the most frequent type of pediatric facial traumatic injury, but their treatment remains controversial. The aim of this retrospective study was to analyze the surgical treatment and long-term outcomes of dentate mandibular fractures in children and adolescents., Material and Methods: Patients with mandibular fractures in the dentate area who were surgically treated in the period from January 1, 2001, to December 31, 2020, were included. The following data were collected: age, gender, cause and mechanism of injury, fracture site and type, associated maxillofacial fractures, the timing of surgical treatment, Facial Injury Severity Scale (FISS) score, surgical approach, number and thickness of plates, hospitalization stay and outcome. Patients were divided into three groups: deciduous (≤6 years, group A), mixed (7-12 years, group B), and permanent (13-18 years, group C) dentitions. Statistical analyses were performed using SPSS software., Results: During the study 91 patients (male: female ratio, 3.8:1), 4 in group A, 12 in group B, and 75 in group C, with 65 single and 52 double fractures were included. An intraoral approach was used in 87% of patients. In group C, 90% of patients were treated with fixation schemes consistent with those suggested in the literature for adults, versus 75% in groups A and B. Median follow-up time was 20 months. No tooth germ injury or facial asymmetry was observed and only six group C patients had post-operative malocclusions. Hardware removal occurred in 22% of the patients., Conclusions: This 20-year retrospective study shows that open reduction and internal fixation of pediatric dentate mandibular fractures caused no tooth germ damage or disturbances of mandibular growth in any dentition stage. Internal fixation schemes were similar to those used for adults, although it was necessary to adapt hardware size and position according to tooth and patient age., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The aim of this multicentric study was to retrospectively evaluate the surgical outcome of atrophic mandible fractures treated with open reduction and rigid fixation (ORIF), using load-bearing plates., Materials and Methods: 55 patients from three trauma centers were retrieved for the study. Inclusion criteria were: edentulous patients with mandibular body fractures; mandibular body thickness <20 mm. Collected data included: cause of fracture; degree of atrophy (according to Luhr's classification); characteristics of the fracture; adequacy of reduction; postoperative complications. All patients were treated with ORIF, using 2.0 mm, large-profile, locking bone plates and 2.4 mm locking bone plates. No bone graft was used in any case., Results: 12 patients were classified as class I atrophy, 18 patients as class II, and 25 patients as class III. Mean mandibular height at the site of fracture was 12.8 mm (ranging from 5.4 mm to 20 mm). 22 were unilateral fractures and 23 were bilateral. Mild displacement was observed in 11 fractures, moderate in 34, severe in 16, and comminution was present in seven fractures. Adequacy of reduction was judged good in 62 fractures and poor in six fractures. Transient weakness of the marginal branch of the facial nerve was recorded in 11 patients and permanent weakness in two patients. All patients achieved a complete fracture healing., Conclusion: External open reduction and rigid fixation (ORIF) with locking, load-bearing plates is a reliable and predictable treatment for atrophic edentulous mandible fracture. Immediate bone grafting should not be considered mandatory unless there is consistent bone loss., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: Achieving functional and anatomic restoration is remarkably difficult in patients with symphyseal mandibular fractures associated with bicondylar fractures. Our objective was to evaluate the functional and esthetic outcomes of a group of patients who underwent surgery using rigid fixation., Patients and Methods: In our study, 25 patients with symphyseal mandibular fractures associated with bicondylar fractures surgically treated from 1998 to 2008 at the Division of Maxillofacial Surgery of the University of Turin were retrospectively analyzed. The standardized evaluation consisted of an evaluation of occlusion, assessment of mandibular motion, and esthetic evaluation of facial width., Results: The patients showed good mandibular motion and good occlusion. After esthetic evaluation of the facial width of the 25 patients, 23 patients were rated as "excellent" or "good.", Conclusion: Successful treatment of multiple mandibular fractures may be achieved by different techniques. The key point is the re-establishment of the transversal bigonial dimension by a correct reconstruction of the mandibular arch.

Purpose: This retrospective study evaluated the long-term results and complications of open reduction and internal fixation of displaced and dislocated fractures of the condylar process., Patients and Methods: Two hundred four patients were treated via various surgical approaches between 1991 and 2005. Fifty patients with a total of 57 treated condylar fractures who underwent complete clinical and radiological documentation were included in this study. Follow-up clinical and radiological evaluations were carried out after an average period of 88 months., Results: We found that 12% of our patients reported temporary weakness of the facial nerve and 4% had mild permanent facial nerve palsy. Clinical and radiological assessment showed satisfactory recovery of facial symmetry. Excellent recovery of function was observed, and very few patients complained of temporomandibular joint-related symptoms. Severe condylar remodeling was observed in 8% of the patients, 47% showed slight or moderate remodeling, and 45% showed no remodeling. A statistically significant association was observed between the presence of condylar remodeling and poor mouth opening at the follow-up examination., Conclusions: Surgical treatment of condylar fractures, in association with postoperative functional therapy, promotes the recovery of function, occlusion, and facial symmetry with few complications. However, some difficulties remain related to the surgeon, the patient, and the objective complexity of this pathology.

The treatment results and the incidence of complications were evaluated retrospectively in a group of 68 patients. They all had mandibular fractures with a tooth in the line of fracture and were treated using miniplates for fixation. The follow up ranged from 1 to 6 years (mean 2.6 years) and 90 fracture sites were involved. Results showed that the incidence of complications when the tooth was extracted was higher (3/12) than when it was left in place (8/78). With regard to both healing of the fracture and fate of the tooth in the line of fracture, it is recommended to retain teeth in the line of fracture, unless there is an absolute indication for extraction. It is advisable to monitor the vitality of teeth adjacent to the fracture line for at least one year.