An analysis of mechanism patterns in pediatric mandible fractures

The mandible is the second most fractured facial bone in children, with potentially severe consequences if not optimally treated. However, data on pediatric mandible fracture epidemiology and management, particularly by injury mechanism, remains limited.

A retrospective chart review was conducted between January 1, 2014, to August 1, 2024, among patients 18 years old and younger who presented with a mandible fracture to a level I pediatric trauma center. Demographic information, injury mechanism, fracture pattern, and hospital course data were analyzed.

We identified 490 patients (median age 10 years; male-predominant). The most common mandible fracture subtypes were condyle, parasymphysis, and angle/ramus; the most common mechanisms of injury were falls from height/standing, bicycle accidents, and recreational sports. Nasal bone, unilateral orbital, unilateral temporal bone, and unilateral ZMC fractures were the most frequent concomitant facial injuries. Approximately one-third had polytrauma, and slightly more than half required hospitalization and surgical intervention. Chi-square analyses showed parasymphyseal, body, and angle/ramus fractures were more common after higher-impact mechanisms, whereas condylar and alveolar fractures were more common after lower-impact mechanisms. Polytrauma was more likely with body and angle/ramus fractures. Hospitalization was more likely with symphyseal, parasymphyseal, body, angle/ramus, and subcondylar fractures. Surgical intervention was more likely with symphyseal, parasymphyseal, body, and angle/ramus fractures and in older patients.

Significant associations exist between mechanism of injury and mandible fracture location. Certain anatomic sites had higher odds of comorbid trauma, hospitalization, and surgical intervention. Understanding these patterns can guide diagnostic evaluation and management of pediatric mandible fractures.