G. A. Swaify, MBChB, DS, BDS, PhD;*
P.J. Dhanrajani, BDS, MDS, MSc**
Riyadh Dental Center, P.O.Box 1.584, Riyadh 11441, Saudi Arabia.

Jawfractures in children form a small percentage of the total jaw fractures which occur in the population. The principles involved in the treatment of facial trauma are the same, whatever the age of the patient. However, for children, the techniques used are necessarily modified by cer­ tain anatomical, physiological, and psychological factors especially related lo childhood. The aim of this paper is to describe the use of a versatile splint for fixation of displaced fractures of the mandible in children, who are less than one year of age,

Unfavorable fractures of the anterior region of the mandible in children who are less than one year of age are difficult to manage, due to anatomic and feeding factors.1 A variety of methods have been used in the past and none had proved to be ideal.2
A universally applicable Gunning splint for the treatment of mandibularbody fractures was used in children aged less than five years.3 On the other hand, conventional methods for the management of mandibular fractures were applied by others. In one such report, it was stated that sixteen out of twenty-nine patients were treated without inter­ maxillary fixation.4In another report on thirty-four mandibular frac­ tures in children, aged two to fifteen years, a fabri­ cated splint, stent or occlusal wafer was used for fixation in patients aged less than four years.5 In another study6 vacuum acrylic splint was used as a method of fixation in seventy-seven patients below the age of five years.
The methods described in the past were often time consuming. Some also required special labo­ ratory procedures and, sometimes, an extra session of anaesthesia. These extra steps, caused inconvenience for both the patient and the surgeon.
The purpose of this article is to introduce the use of a versatile method of fractured mandible fixation for children less than one year old.
Technique
This technique has been utilized in six patients. Their ages ranged from nine to twelve months, with a mean of 11.6 months. Three of them were females and three were males. The fractures were in the region of the symphysis and parasymphysis except one who had ‘a dento-alveolar fracture of the lower anterior segment.
All of the fractures were due to falls except one which was caused by a domestic accident (Table 1). All cases were treated by closed reduction under general anaesthesia using a splint secured with circumandibular wiring. No intermaxillary fixation was required. On four occasions two cir­ cumandibular wires were applied, and in the other two cases three circumandibular wires were used.
The splint was prepared from oropharyngeal air­ way* [Fig. 1 ]. The proper size was chosen to fit the curvature of the mandibular arch. The guard was cut off, then the airway was split longitudinally leaving a longer lingual lip [Fig. 2|. The prepared splint was fenestrated to accommodate the teeth on the arch [Fig. 3].
The splint was rounded at the edges, the fracture reduced, and the splint was seated on the man­ dibular arch and fastened in place using circuman- dibular wires. Wires were so placed to include the fractured line in between to effect maximum stability.

All patients showed proper alignment of the frac­ tured bone ends postoperatively [Figs. 4a-b, 5a-b], which were maintained for the healing period. The immobilization period ranged from 19-24 days with a mean of 21.16 days without any complica­ tions (Table 1 J.
It was interesting to note that the average hos­ pitalization in this study was 2.83 days. Only one child was kept for five days because his haemoglobin level had to be raised before anaesthesia.
Foflow-up period of more than one year showed good bone healing and normal occlusion.

 
Oropharyngeal airways were never used before as splints for mandibular fractures. The airway tub­ ing has obvious advantages of being soft, biologi­ cally compatible, easy to handle, adaptable by carving into required shapes and is available in dif­ ferent sizes. The technique is easy to carry out and does not require any special instrumentation, or laboratory procedures, or extra sessions of anaes­ thesia.
The stability obtained with this type of splint is excellent and, since it is one jaw fixation, the splint does not interfere with feeding and swallowing which are of great importance for the infants and their parents.