Mandibular greenstick fracturehealing: A conservative approach

Abstract

It is common that pediatric maxillofacial fractures develop after a traumatism. The lower calcification of pediatric bones allows them to be flexed in response to external forces, producing greenstick fractures. Many injuries that require surgical management in adults, could be conservatively managed in children due to anatomical, physiological and psychological factors. This is a case report of a six-year-old boy that presented a greenstick fracture of the mandibular body due to a vehicle accident. At clinical examination, it was observed an increase in mandibular left angle volume and intraoral lacerations. Radiographic exams confirmed an incomplete fracture line without displacement next to the permanent mandibular left first molar. The management was conservative: analgesic and anti-inflammatory therapy, soft diet, physical activities restriction and compliance with oral hygiene. The longitudinal follow-up during a year showed a good prognosis in mandible growth and development.

Introduction

During the first years of life, children are not exempt from suffering injuries that could threaten their optimal growth and development, becoming our most vulnerable population at that stage . In fact, head wounds could appear due to pediatric traumas, because head is the most common body part involved in accidents . The pediatric body has many features that provide protection and resilience to traumatic forces in craneofacial injuries, in comparison to adults, such as a wider forehead and cranial mass that cover the face, fibroelastic bone tissue with more cancellous bone ratio and non-erupted permanent dentition that offers more stability .

Nevertheless, it is common that pediatric maxillofacial fractures develop after a traumatism. The most affected bones are the nasal bone and the mandible, with an incidence of 60% . In general, the lower calcification allows the pediatric bones to be flexed in response to external forces, producing greenstick fractures , where one bone cortex will be broken and the other one will be bent, without losing bone continuity .

Many injuries that require surgical management in adults, could be conservatively managed in children . So, it can be said that children aren’t just “small adults”, due to the anatomical, physiological and psychological factors . The aim of this paper is to report the case of a six-year-old boy that presented a greenstick fracture of the mandibular body, and its conservative management with longitudinal follow-up during a year.

Case report

A healthy six year-four months old male attended dental service at the Postgraduate Pediatric Dentistry Clinic of San Luis Potosi University, San Luis Potosi, Mexico complaining of suffering an accident where he was hit by a running motorcycle while the boy was walking through a dirt road. The impact was directed to the left side of the mandible, causing immediate intraoral bleeding, which stopped until the next day; however, the boy didn’t lose consciousness, only a mild headache. The same day, he attended a Hospital urgently, where he was prescribed with naproxen and acetaminophen suspension, and was referred to the Postgraduate Clinic for radiographic examination to discard head and facial fractures, since the boy didn’t had any other sign or symptom of health implication.

The boy attended to the Pediatric Dentistry Clinic four days after the accident accompanied by his mother, who reported that the child couldn’t eat solid food, talk properly or achieve an adequate oral hygiene in the previous days. The extraoral examination revealed an increase in mandibular left angle volume, and the formation of crusting on upper lip and left side of the chin. The intraoral examination revealed lacerations associated to primary maxillary left lateral incisor and to primary mandibular left second molar. The primary maxillary left central and lateral incisors presented extrusive luxation with increased mobility, causing occlusion interference ( Fig. 1 ). The radiographic examination revealed a fracture line between the primary mandibular left second molar and permanent mandibular left first molar, likely affecting the developing apex of the latter one ( Fig. 2 ).

Fig. 1
(A, B, C) Initial intraoral assessment. Malocclusion and lacerations caused by trauma. (D, E) Initial extraoral assessment. Mandibular left angle with increased volume and crusts.

Fig. 2
(A) Panoramic radiograph. A fracture line is revealed in lower left side. (B) Mandibular occlusal view. Vestibular bone cortex is displaced, lingual cortex is bent. (C) Periapical radiograph. Fracture line between primary mandibular left second molar and permanent mandibular left first molar. (D) Maxillary occlusal view. Primary left central and lateral incisors present extrusive luxation.

A consultation was requested with Oral and Maxillofacial surgeons, and with their support, the boy was diagnosed with a greenstick fracture in the left side of the mandibular body, without displacement. Through a Computed Tomography there were discarded other facial fractures, paying special attention to mandibular condyles ( Fig. 3 ). The treatment plan proposed was conservative, with the following indications: Feeding with soft diet, restriction of physical activities, compliance with hygiene oral techniques, continuing with the analgesic and anti-inflammatory therapy (As prescribed with naproxen and acetaminophen. No antibiotic was required), attending to the follow-up appointments, and avoiding long-term dental procedures with extended mouth opening. One week later, the primary maxillary left central and lateral incisors were revaluated, and decided to perform the extraction of both teeth under local anesthesia due to their poor prognosis and occlusal interference (anterior crossbite).

Jan 12, 2020 | Posted by in General Dentistry | Comments Off on Mandibular greenstick fracturehealing: A conservative approach
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