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