C-arm-assisted internal fixation of pediatric mandibular fracture

Introduction: Dentition is one of the main concerns while managing pediatric mandibular fractures. The aim of this study was to assess the results of the usage of intraoperative images with C-arm to identify and protect the roots of nonerupted teeth during open reduction and internal fixation (OR/IF) of pediatric mandibular fractures. Patients and Methods: This prospective study was conducted on children who had mandibular fractures with unerupted mandibular teeth appearing on panoramic examination. All patients were managed by OR/IF by titanium miniplates using manual maxillomandibular fixation treated under general anesthesia. Titanium miniplate was positioned according to preoperative radiology. Then C-arm images were taken to confirm the screws position away from the nonerupted teeth. Lastly, the screws were inserted at C-arm-confirmed safe position. Then the results were assessed such as reliability, difficulties of the procedures, operative time, dental occlusion, average intrinsic vertical mouth opening, and complication. Results: A total of 20 children with parasymphyseal fractures, with mean age of 6.5 (range: 4–9) years, were included. No difficulties were detected during application of the C-arm during surgery regarding position or projection, and the registered views were clearly seen and easily interpreted. Thus, added duration for C-arm use did not significantly elongate the operative time. Postoperative radiology confirmed proper position of all fixed screws away for the teeth root or unerupted teeth. Conclusion: Operative C-arm-guided plate screws positioning and fixation can effectively obviate the risk of injury to tooth root or bud during OR/IF of mandibular. © 2018 The Egyptian Journal of Otolaryngology.