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C-arm-assisted internal fixation of pediatric mandibular fracture



Dentition is one of the main concerns while managing pediatric mandibular fractures. The aim of this study was to assess the results of the usage of intraoperative images with C-arm to identify and protect the roots of nonerupted teeth during open reduction and internal fixation (OR/IF) of pediatric mandibular fractures.

Patients and Methods

This prospective study was conducted on children who had mandibular fractures with unerupted mandibular teeth appearing on panoramic examination. All patients were managed by OR/IF by titanium miniplates using manual maxillomandibular fixation treated under general anesthesia. Titanium miniplate was positioned according to preoperative radiology. Then C-arm images were taken to confirm the screws position away from the nonerupted teeth. Lastly, the screws were inserted at C-arm-confirmed safe position. Then the results were assessed such as reliability, difficulties of the procedures, operative time, dental occlusion, average intrinsic vertical mouth opening, and complication.


A total of 20 children with parasymphyseal fractures, with mean age of 6.5 (range: 4–9) years, were included. No difficulties were detected during application of the C-arm during surgery regarding position or projection, and the registered views were clearly seen and easily interpreted. Thus, added duration for C-arm use did not significantly elongate the operative time. Postoperative radiology confirmed proper position of all fixed screws away for the teeth root or unerupted teeth.


Operative C-arm-guided plate screws positioning and fixation can effectively obviate the risk of injury to tooth root or bud during OR/IF of mandibular.


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Correspondence to Mohammad W. El-Anwar MD.

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El-Anwar, M.W., Salah, M. & Abdulmonaem, G. C-arm-assisted internal fixation of pediatric mandibular fracture. Egypt J Otolaryngol 34, 122–126 (2018).

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  • C-arm
  • children
  • fracture mandible
  • internal fixation
  • maxillomandibular fixation