Circummandibular Wiring of Symphysis Fracture in a Five-Year-Old Child

The treatment of pediatric maxillofacial fractures is unique due to the psychological, physiological, developmental, and anatomical characteristics of children. Method. This case report describes the management of symphysis fracture of mandible in a 5-year-old boy. The fracture was treated by acrylic splint with circummandibular wiring. Results. The splint was removed after 3 weeks. The patient had no complaints, and radiograph revealed a healed fracture. Conclusion. The clinical outcome in the present case indicates the management of mandibular fractures in pediatric patients using acrylic splint with circummandibular wiring. 1. Introduction Mandibular fractures are the most common (56%) facial skeletal injury in hospitalized pediatric trauma patients [1, 2]. Boys are affected twice as frequently as girls [2, 3]. Dentoalveolar injuries are more frequent facial injury (60%) in children (especially under the age of 5) but rarely require hospitalization. In pediatric patients symphysis and parasymphysis fractures account for 15%–20% and body fracture rare [4]. The treatment choice of fractures in the pediatric mandible depends on the age and the state of tooth development. Major injuries affecting the face are associated with hyperactivity of the child, fall, road traffic accidents (RTA), assault, and child abuses which are the most frequent risks of facial bone fractures in children [5]. Majority of the body and symphysis fractures in children are undisplaced because of elasticity of mandible and embedded tooth buds that holds the fragments together “like glue” [6, 7]. If displaced, closed reduction and immobilization are performed. The following paper will review the triage, evaluation, and management of facial trauma in children. It highlights the role of acrylic splint with the use of circummandibular wiring technique in the management of symphysis fracture in a 5-year-old child. 2. Case Report A 5-year-old male child reported to the Outpatient Department of Pedodontics and Preventive Dentistry, MNR Dental College and Hospital, Sangareddy, India, with a history of fall from steps. The patient was conscious, not well oriented with dressings in the lower jaw andno history of convulsions, vomiting, and bleeding from ear and nose. Haematological parameters such as blood count, CT, and BT were normal at the time of examination. 3. Clinical and Radiological Examination Extraoral examination revealed the presence of a swelling in the anterior region of mandible. There was limited mouth opening because of pain and possible muscle spasm. On intraoral