Conservative Treatment of a Trauma-related Mandibular Fracture in a Pediatric Patient with Severe Intellectual Disability

Abstract

The frequency of oral trauma in children with disabilities is higher than that in typically developing children, and tends to increase in children with multiple disabilities.

Here, we describe a case of mandibular fracture in a 14-year-old girl with intellectual disability and epilepsy. The patient presented to our clinic complaining of trismus and swelling of the left cheek. Two days prior, she had fallen and her lower jaw had struck the floor. Panoramic X-ray examination, posterior-anterior X-ray examination, and computerized tomography （CT） showed that the left mandibular condyle and right mandibular body were fractured. We chose conservative treatment for the condyle fracture in accordance with the guideline （“Clinical Practice Guidelines for Oral and Maxillofacial Trauma 2015”）.

Various types of plate fixation or intermaxillary fixation are recommended for the treatment of fracture of the mandibular body, and we too chose conservative treatment for this fracture because we suspected that the patient’s developmental level was insufficient to accept fixation；moreover, fracture of the mandibular body was incomplete. Thus, we monitored the healing process by CT follow-up.

Four months after the injury, the patient could open her mouth 40 mm without pain and/or displacement. Seven months after the injury, we confirmed that the fracture line had disappeared, both at the mandibular condyle and at the mandibular body. The fractures fully recovered and neither facial asymmetry nor malocclusion was observed. The present report indicates that conservative treatment may be appropriate for children with severe intellectual disability with minimal intervention.