Assessment of pediatric mandibular fracture management in France

Mandibular fractures in children present management challenges due to pediatric-specific factors such as mandibular growth and the presence of dental germs. There are few surgeons specifically trained to treat these fractures, and there are no national or international guidelines. Management depends on several factors, including the child's age and the location of the fracture. Treatment options include functional treatment, closed reduction with or without immobilization, and surgery. The aim of this study was to assess the current management strategies for pediatric mandibular fractures in France, based on a national survey. A questionnaire based on two clinical cases of children of different ages, presenting mandibular fractures in different locations, was sent to the referring pediatric surgeon of 25 centers in France that manage pediatric maxillofacial trauma. The questions focused on the choice of treatment, postoperative instructions, and follow-up. The data were analyzed descriptively. Off the 25 centers, all responded to the questionnaire. For the first patient, 92 % of the surgeons hospitalized the child. Among them, 76 % opted for open reduction and internal fixation (ORIF) for the parasymphyseal fracture, and 72 % adopted the same approach for the mandibular body fracture. In most cases, the fixation material was left in place for at least three months. For the second patient, 88 % of the surgeons also hospitalized the child. For condylar fractures, 84 % chose functional treatment. 56 % of practitioners opted for ORIF for the mandibular body fracture. Regarding the use of resorbable plates, only 1 out of 25 centers used this type of material. Concerning the specific training of surgeons, the study shows that among the 25 centers: 52 % reported having surgeons with specific pediatric training. 48 % of the centers had access to a dental prosthetist capable of fabricating retention splints. This study is the first on this subject in France. It highlights significant variability in the management of pediatric mandibular fractures in France and underscore the need for standardized treatment protocols. Future studies should focus on developing standardized guidelines and evaluated long-term outcome to improve both surgical and conservative approaches.