C.E. Zimmermann, M.J. Troulis, L.B. Kaban

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Pediatric facial fractures: recent advances in prevention, diagnosis and management C.E. Zimmermann, M.J. Troulis, L.B. Kaban International Journal of Oral and Maxillofacial Surgery Volume 35, Issue 1, Pages 2-13 (January 2006) DOI: 10.1016/j.ijom.2005.09.014 Copyright © 2005 International Association of Oral and Maxillofacial Surgeons Terms and Conditions

Fig. 1 (A) Occlusal radiograph of symphyseal fracture, (B) treated using a lingual splint. The splint can be wired to the teeth (preferably) or stabilized with circumamandibular wires (from BAUMANN et al., p. 45112). International Journal of Oral and Maxillofacial Surgery 2006 35, 2-13DOI: (10.1016/j.ijom.2005.09.014) Copyright © 2005 International Association of Oral and Maxillofacial Surgeons Terms and Conditions

Fig. 2 Panoramic radiograph shows miniplate fixation of a mandibular fracture at the inferior border. The arch bars were used for stabilization of the dentoalveolar segments (photographs courtesy of Dr. Meredith August) (from BAUMANN et al., p. 45312). International Journal of Oral and Maxillofacial Surgery 2006 35, 2-13DOI: (10.1016/j.ijom.2005.09.014) Copyright © 2005 International Association of Oral and Maxillofacial Surgeons Terms and Conditions

Fig. 3 (A) Frontal photograph of 15-year-old boy who suffered a left subcondylar fracture while snowboarding. He was treated with a 7-day course of maxillomandibular fixation. On attempt to remove the wire fixation he had a severe contralateral open bite and severe pain (requiring replacement of the MMF). He was referred to the MGH OMFS clinic. (B) Axial CT scan confirms that the left condyle was dislocated out of the fossa. Endoscopic views (C and D) show the condylar stump well-reduced and fixed with 2, 2.0 screws. The proximal ramus was then fixed to the mandible with a 2.0 plate. The postoperative panoramic radiograph (E) shows the proper alignment of the ramus/condyle unit. Postoperative frontal photograph (F) shows good symmetry and a normal interincisal opening with no deflection (from BAUMANN et al., p. 458–45912). International Journal of Oral and Maxillofacial Surgery 2006 35, 2-13DOI: (10.1016/j.ijom.2005.09.014) Copyright © 2005 International Association of Oral and Maxillofacial Surgeons Terms and Conditions

Fig. 4 Young boy who sustained a blow to the left cheek. (A) Frontal and (B) submental photographs illustrate the typical findings of a zygomatic complex fracture: periorbital ecchymosis (mild in this case), antimongoloid slant of the lateral canthus, depression of the cheek. (B) Submental view better illustrates the marked cheek depression. (C) Computed tomographic image demonstrates fracture at anterior maxillary wall and a fluid-filed antrum. (D) Intraoperative photograph shows the access via an intraoral, vestibular incision, the good reduction (achieved in this case with a Carroll–Gerard screw) and rigid internal fixation using 2.0mm plates (Synthes Maxillofacial, Paoli PA). (E) Frontal and (F) Submental photographs, 1 year postoperatively, demonstrate symmetry of the zygomas. (G) Postoperative Water's view confirms the proper reduction and symmetry (from BAUMANN et al., p. 43111). International Journal of Oral and Maxillofacial Surgery 2006 35, 2-13DOI: (10.1016/j.ijom.2005.09.014) Copyright © 2005 International Association of Oral and Maxillofacial Surgeons Terms and Conditions

Fig. 4 Young boy who sustained a blow to the left cheek. (A) Frontal and (B) submental photographs illustrate the typical findings of a zygomatic complex fracture: periorbital ecchymosis (mild in this case), antimongoloid slant of the lateral canthus, depression of the cheek. (B) Submental view better illustrates the marked cheek depression. (C) Computed tomographic image demonstrates fracture at anterior maxillary wall and a fluid-filed antrum. (D) Intraoperative photograph shows the access via an intraoral, vestibular incision, the good reduction (achieved in this case with a Carroll–Gerard screw) and rigid internal fixation using 2.0mm plates (Synthes Maxillofacial, Paoli PA). (E) Frontal and (F) Submental photographs, 1 year postoperatively, demonstrate symmetry of the zygomas. (G) Postoperative Water's view confirms the proper reduction and symmetry (from BAUMANN et al., p. 43111). International Journal of Oral and Maxillofacial Surgery 2006 35, 2-13DOI: (10.1016/j.ijom.2005.09.014) Copyright © 2005 International Association of Oral and Maxillofacial Surgeons Terms and Conditions