Page 81 - 7. FINAL draft Compendium 2019 2020_22072022

ORAL ACRYLIC SPLINT AS CONSERVATIVE MANAGEMENT IN MAXILLOFACIAL INJURY
AMONG CHILDREN: A CASE SERIES

Ilyas N, Salleh H

Introduction: Maxillofacial injuries occur less commonly in children. However, the
incidence increases with increasing age. In Malaysia, the reported incidence of maxillofacial
fractures ranging from 7.8% to 16.8% in children age 10 years old and below. The most
common causes of maxillofacial fractures are motor vehicle accident, sports, interpersonal
violence, and falls. Case study: This report is to present a case-series of 7-year-old and 4-
year-old paediatric patients who reported in our clinic for management of maxillofacial
trauma using oral acrylic splint. The first case is a patient with Le fort 1 fracture with palatal
split, left frontozygomatic fracture and right lateral orbital wall fracture. Maxillary occlusal
splint was constructed and showed signs of healing after a series of review. The second
case was diagnosed with symphysis of mandible fracture with underlying multiple avulsion
of upper front teeth. A cap splint was constructed and cemented under general anaesthesia
on lower mandible to optimize the healing process at the fracture site. The fracture site
resolved after 6 weeks of cap splint placement. Discussion: Mandibular fractures are the
most common facial skeletal injury in paediatric population particularly symphyseal and
parasymphyseal fractures due to presence of the canine tooth buds. This resulting in a
stress point at the inferior border of the mandible. The management of maxillofacial
fracture in paediatric population is often complex and challenging, owing to the unique
paediatric facial structure. This could be due to the anatomical complexity, growing
paediatric patient and the presence of developing tooth bud. The goal of treatment in
managing maxillofacial injury of paediatric patient is to restore the function and preinjury
occlusion and to re-establish facial symmetry as well as to minimize disruption of normal
mandible growth and development. Paediatric mandibular fracture without displacement
or in the absence of malocclusion may be managed conservatively with close observation,
soft diet, physical activity precautions and analgesics. The displaced fractures of the
mandible may be treated with Intermaxillary Fixation (IMF), miniplate fixation or
placement of an acrylic lingual splint. For both cases, the placement of acrylic splints was
an option which resulted in an uneventful postoperative recovery owing to child’s greater
osteogenic potential and faster healing response. Conclusion: Closed reduction oral acrylic
splint is recommended in the management of maxillofacial trauma in paediatric patient,
closed reduction using due to anatomical complexity and presence of tooth bud within the
maxilla and mandible.

Oral presentation at the Kelantan Research Day 2019 on 14 November 2019
th
Dr Nurfarhana Ilyas
Dr Hassiah Salleh
Dental Officer
Department of Paediatric Dentistry
Raja Perempuan Zainab II Hospital Kota Bharu

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