Surgical management of maxillary trauma in pediatric special needs patient using modified cap splint

Abstract

Pediatric maxillofacial trauma is a rare entity, which is primarily the reason for an individual surgeon's inexperience in managing such injuries. More so, maxillary injuries are infrequent. Pediatric maxillofacial injuries are usually a result of blunt force trauma such as falls, motor vehicle accidents, bicycle injuries, sports-related injuries, assault, and child abuse. The atypical pattern of facial injuries in the pediatric population necessitates each surgeon to approach individual cases with a unique and innovative technique of management, while still following the basic principles of surgical management of maxillofacial injuries. Since facial trauma and surgical interventions both have the potential to lead to disturbance in growth and development, management should be as conservative as possible. The foundation of any surgical intervention must be developed keeping in perspective, the future growth, and development of dentofacial structures. Pediatric facial trauma management is in itself a disconcerting situation for a maxillofacial surgeon, but when a special needs child is involved it becomes an even more perplex decision. We present a case of maxillary trauma in a pediatric patient with global developmental delay, the treatment dilemma, and a review of current literature.

Keywords: Global developmental delay; maxillary fractures; modified cap splint; pediatric fractures; pediatric maxillary fractures; surgical management of pediatric maxillary fractures.

Figure 1

Preoperative orthopantomogram showing left dentoalveolar fracture

Figure 2

Preoperative occlusion

Figure 3

Splint for maxilla to stabilize the fractured dentoalveolar segment

Figure 4

Splint in situ and suspended from the maxilla using titanium screws and stainless steel wires

Figure 5

Postoperative orthopantomogram

Figure 6

Postoperative occlusion