Conservative management of pediatric mandibular fractures with cap splints- A systematic review

Mandible is the second most common bone involved among pediatric facial fractures, and the open reduction and internal fixation (ORIF) technique used for its management results in faster bone remodeling and quicker functional recovery. However, it can lead to damage to the periosteum and surrounding tooth buds, and may require a second surgery for removal. Therefore, conservative methods always remain mainstay for management among pediatric patients. This systematic review evaluates the use of cap splints in managing pediatric mandibular fractures and compares this approach with other closed reduction methods.

A priori protocol was prepared, and registered in the International Prospective Register of Systematic Reviews (CRD42024531959). A comprehensive literature search was performed electronically in PubMed, EMBASE, Web of Science, and Scopus till December 31, 2024, whereas a grey literature search was carried out on Google Scholar and open grey. Two reviewers independently assessed the methodological quality of the included studies by using the appropriate Joanna Briggs Institute's (JBI) critical appraisal checklist for case reports, case series, and retrospective cohort studies. For a prospective cohort study, the risk of bias in non-randomized studies of intervention was used for quality assessment.

The database search revealed 2308 records, and 48 records were obtained from grey literature and citation search. A total of 47 studies (28 case reports, 13 case series, three retrospective studies, and three prospective non-randomized interventions) were finally included in the review. The different modalities used were cap splint with luting cement, circum-mandibular wiring, interdental wiring, and arch bar fixation. Among the included studies, one case report and three case series had a high risk of bias. Similarly, all retrospective studies had a high risk of bias.

Cap splint can be recommended as a treatment option for non-displaced pediatric mandibular fractures that do not involve the condyle. Luting cement can be used as an alternative to circum-mandibular wiring.