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Case of Accidental Trauma Resulting in Condylar Fractures in 3-Month-Old
Maggie M Mouzourakis1, Sarah S Seo1,2, Resmiye Oral3,4
1Section of Otolaryngology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.
Insights
Diagnosing infant mandibular fractures is difficult due to vague symptoms. This case highlights how a sublingual hematoma, initially concerning for abuse, was accurately diagnosed as accidental trauma through a multidisciplinary approach.
Area of Science:
- Pediatric Traumatology
- Craniofacial Surgery
- Pediatric Radiology
Background:
- Mandibular fractures are common pediatric craniofacial injuries, but rare in infants.
- Diagnosis in infants is complicated by nonspecific symptoms and imaging limitations.
- Sublingual hematoma (Coleman's sign) can be an indicator of mandibular trauma.
Abstract:
While mandibular fractures represent the most common craniofacial injury in the pediatric population, craniofacial fractures in infants are rare. Diagnosis is challenging with nonspecific presenting symptoms and often limited radiographic imaging. We report a case of nondisplaced mandibular condylar head fractures in a 3-month-old patient as a result of a fall with impact onto the chin, with associated sublingual hematoma (Coleman's sign). Although the initially observed sole finding of sublingual hematoma raised concern for child physical abuse, detailed history, oral exam, and multidisciplinary review of radiologic records by pediatrics, otolaryngology, and child protection teams established the accidental trauma diagnosis. The patient was managed conservatively with normal resumption of feeding. Detailed history and multidisciplinary approach to the management of pediatric facial trauma are important in establishing diagnoses and management.
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