Pediatric emergency medicine trisk 3252 3252

Maxillary Fractures Premaxillary or anterior maxillary alveolar bone (commonly referred to as alveolar ridge) fractures are a common finding associated with the displacement or avulsion of maxillary anterior teeth Acute management can be performed by the emergency physician Gentle digital manipulation of the labial plate of bone can be guided back into position under local anesthesia Infiltration with 2% lidocaine with 1:100,000 epinephrine is commonly used The bone fragment can be held in place temporarily by aluminum foil (three thicknesses) molded over the teeth and alveolar ridge This emergency splint should be held in place by having the child gently bite down A dental consultant should be contacted as soon as possible for fabrication of a more permanent dental splint Splinting the loose teeth and suturing the gingival tissue hold the bone fragments in place Commonly associated mandibular and other facial fractures are covered in greater detail in Chapter 107 Facial Trauma FIGURE 105.6 Position for the reduction of a dislocated mandible