Pediatric emergency medicine trisk 3292 3292

Temporomandibular joint dislocation may not only result from a direct blow to the chin but also may occur while yawning or opening the mouth widely With dislocation, the condyle of the mandible is displaced anteriorly and is prevented from sliding back into place by spasm of the jaw muscles Preauricular swelling and inability to close the mouth fully are the key features on physical examination Current Evidence Mandibular fractures are treated more conservatively in children compared to adults due to the risk of injury to the permanent tooth buds and mandibular growth retardation Most mandibular fractures can be treated with closed reduction and maxillomandibular fixation A soft or liquid diet is recommended Displaced fractures commonly require open reduction, internal fixation, or the use of splints Antibiotics are generally recommended as these fractures are often in communication with the oral cavity, although there is limited data to support this recommendation Reduction of temporomandibular joint dislocations may be facilitated with the use of a benzodiazepine to decrease muscle spasm; procedural sedation may also be required Downward traction is applied to the posterior aspect of the mandible The chin is then pushed posteriorly to allow the condyle to return to its fossa Orbital Fracture Goals of Treatment The primary goals in treatment of orbital fractures are to recognize the signs of extraocular muscle entrapment, and if present, to obtain prompt ophthalmologic consultation to determine the need and timing of surgical repair to avoid muscle ischemia and fibrosis CLINICAL PEARLS AND PITFALLS In children, the floor of the orbit may fracture in a linear pattern that snaps back to create a “trapdoor” fracture Fractures at this site can cause inferior rectus muscle entrapment, which may be identified by limitation of upward gaze Decreased vision in a patient with orbital trauma may indicate a retrobulbar hemorrhage Clinical Considerations